Health Care Expenditures Among Adults With Diabetes After Oregon's Medicaid Expansion

Diabetes Care. 2020 Mar;43(3):572-579. doi: 10.2337/dc19-1343. Epub 2019 Dec 19.

Abstract

Objective: To compare trends in Medicaid expenditures among adults with diabetes who were newly eligible due to the Affordable Care Act (ACA) Medicaid expansion to trends among those previously eligible.

Research design and methods: Using Oregon Medicaid administrative data from 1 January 2014 to 30 September 2016, a retrospective cohort study was conducted with propensity score-matched Medicaid eligibility groups (newly and previously eligible). Outcome measures included total per-member per-month (PMPM) Medicaid expenditures and PMPM expenditures in the following 12 categories: inpatient visits, emergency department visits, primary care physician visits, specialist visits, prescription drugs, transportation services, tests, imaging and echography, procedures, durable medical equipment, evaluation and management, and other or unknown services.

Results: Total PMPM Medicaid expenditures for newly eligible enrollees with diabetes were initially considerably lower compared with PMPM expenditures for matched previously eligible enrollees during the first postexpansion quarter (mean values $561 vs. $793 PMPM, P = 0.018). Within the first three postexpansion quarters, PMPM expenditures of the newly eligible increased to a similar but slightly lower level. Afterward, PMPM expenditures of both groups continued to increase steadily. Most of the overall PMPM expenditure increase among the newly eligible was due to rapidly increasing prescription drug expenditures.

Conclusions: Newly eligible Medicaid enrollees with diabetes had slightly lower PMPM expenditures than previously eligible Medicaid enrollees. The increase in PMPM prescription drug expenditures suggests greater access to treatment over time.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Diabetes Mellitus / economics
  • Diabetes Mellitus / epidemiology
  • Diabetes Mellitus / therapy*
  • Eligibility Determination / economics
  • Eligibility Determination / statistics & numerical data
  • Emergency Service, Hospital / economics
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Health Expenditures / statistics & numerical data*
  • Health Services Accessibility* / economics
  • Health Services Accessibility* / organization & administration
  • Health Services Accessibility* / statistics & numerical data
  • Humans
  • Male
  • Medicaid* / economics
  • Medicaid* / organization & administration
  • Medicaid* / statistics & numerical data
  • Middle Aged
  • Oregon / epidemiology
  • Patient Protection and Affordable Care Act* / economics
  • Patient Protection and Affordable Care Act* / statistics & numerical data
  • Retrospective Studies
  • United States / epidemiology