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. 2018 Aug;53 Suppl 1(Suppl Suppl 1):2821-2838.
doi: 10.1111/1475-6773.12814. Epub 2017 Dec 12.

Medicaid Expansion and Health Plan Quality in Medicaid Managed Care

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Free PMC article

Medicaid Expansion and Health Plan Quality in Medicaid Managed Care

Chima D Ndumele et al. Health Serv Res. .
Free PMC article

Abstract

Objective: To assess the effect of the 2014 Medicaid expansion on Medicaid managed care plan quality.

Data sources: Three composite measures of plan-level quality constructed from the Health Care Effectiveness Data and Information Set.

Study setting: One hundred and sixty-three plans in 27 Medicaid expansion states and 100 plans in 14 nonexpansion states.

Study design: Quasi-experimental difference-in-differences (DID) analysis, comparing quality before (2011-13) and after (2014-15) Medicaid expansion in states that elected to expand Medicaid eligibility and those that did not.

Principal findings: Mean plan enrollment increased from 130,533 to 274,259 in expansion states and from 105,449 to 148,194 in nonexpansion states. The proportion of enrollees receiving recommended preventive care increased from 62.6 to 65.2 percent in expansion states and from 59.3 to 62.5 percent in nonexpansion states (adjusted DID: -0.7 percentage points [95% CI -2.2, 0.7]). The proportion of enrollees receiving recommended chronic disease care management increased from 65.4 to 66.0 percent in expansion states and from 62.5 to 63.1 percent in nonexpansion states (adjusted DID: 1.1 percentage points [95% CI -0.5, 2.6]). We observed similar patterns for the receipt of recommended maternity care.

Conclusions: Medicaid expansion increased enrollment in managed care plans, but it did not result in erosion of quality.

Keywords: Medicaid; managed care; quality.

Figures

Figure 1
Figure 1
Average Medicaid Managed Care Plan Enrollment [Color figure can be viewed at http://wileyonlinelibrary.com ]

Note. Analysis limited to plans with Health Care Effectiveness Data and Information Set measures available for 2014–15. Expansion states category includes states that expanded Medicaid eligibility in 2014 or 2015.

Figure 2
Figure 2
Results of Difference‐in‐Differences for Woodwork Subgroups [Color figure can be viewed at http://wileyonlinelibrary.com ]

Note. Composite quality scores reflect average Z‐score across relevant individual quality measures and rescaled to reflect raw composite mean and standard deviation. Adjusted results reflect ordinary least‐squares regression with state and year fixed effects and plan‐level controls for total membership, market share, profit status, and whether the plan is Medicaid‐only, weighted by the measure's eligible population (or total plan population for the composite and smoking measures). “Woodwork plans” are those in nonexpansion states that saw increases in enrollment (greater than the 75th percentile) between 2013 and 2014. “Woodwork effect” analysis estimates effect for “woodwork plans” relative to “nonwoodwork plans” in nonexpansion states.

Figure 3
Figure 3
Results of Difference‐in‐Differences, Stratified by the Magnitude of Eligibility Increase [Color figure can be viewed at http://wileyonlinelibrary.com ]

Note. Composite quality scores reflect average Z‐score across relevant individual quality measures and rescaled to reflect raw composite mean and standard deviation. Adjusted results reflect ordinary least‐squares regression with state and year fixed effects and plan‐level controls for total membership, market share, profit status, and whether the plan is Medicaid‐only, weighted by the measure's eligible population (or total plan population for the composite and smoking measures). Small and large changes in Medicaid eligibility defined using the median change in the 2013–15 federal poverty level (FPL) threshold among expansion states.

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