Interruptions in Medicaid Coverage and Risk for Hospitalization for Ambulatory Care–Sensitive Conditions

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Abstract

Background:

Many low-income U.S. citizens experience interruptions in health insurance coverage.

Objective:

To determine the rate of hospitalization for ambulatory care–sensitive conditions among Medicaid beneficiaries with interruptions in coverage.

Design:

Retrospective cohort study.

Setting:

California Medicaid population.

Patients:

4 735 797 adults in California age 18 to 64 years who received a minimum of 1 month of Medicaid coverage between 1998 to 2002.

Measurement:

Time to hospitalization for an ambulatory care–sensitive condition.

Results:

Sixty-two percent of Medicaid beneficiaries experienced at least 1 interruption in coverage during the study period. The 3 most common ambulatory care–sensitive conditions resulting in a hospitalization were heart failure, diabetes, and chronic obstructive pulmonary disease. Interruptions in coverage were associated with a higher risk for hospitalization for an ambulatory care–sensitive condition (adjusted hazard ratio, 3.66 [95% CI, 3.59 to 3.72]; P < 0.001). In subgroup analyses, the association between interrupted coverage and hospitalization was stronger for beneficiaries eligible through the Temporary Aid to Needy Families program (adjusted hazard ratio, 8.56 [CI, 8.06 to 9.08]) than for beneficiaries eligible through the Supplemental Security Income program (adjusted hazard ratio, 1.72 [CI, 1.67 to 1.76]), who typically retain Medicare coverage even when their Medicaid coverage is interrupted.

Limitation:

The study lacked information on why interruptions occurred and whether beneficiaries with interruptions transitioned to other insurance coverage.

Conclusion:

Interruptions in Medicaid coverage are associated with a higher rate of hospitalization for ambulatory care–sensitive conditions. Policies that reduce the frequency of interruptions in Medicaid coverage might prevent some of the health events that trigger hospitalization and high-cost health care spending.

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