Ohio’s Medicaid Expansion and Unmet Health Needs Among Low-Income Women of Reproductive Age
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Objective To examine changes in the prevalence and odds of unmet healthcare needs and healthcare utilization among low-income women of reproductive age (WRA) after Ohio’s 2014, ACA-associated Medicaid expansion, which extended coverage to non-senior adults with a family income ≤ 138% of the federal poverty level. Methods We analyzed publically available data from the 2012 and 2015 Ohio Medicaid Assessment Survey (OMAS), a cross-sectional telephone survey of Ohio’s non-institutionalized adult population. The study included 489 low-income women in 2012 and 1273 in 2015 aged 19–44 years who were newly eligible for Medicaid after expansion in January 2014. Four unmet healthcare need and three healthcare utilization measures were examined. We fit survey-weighted logistic regression models adjusted for race/ethnicity, working status, and educational attainment to determine whether the odds of each measure differed between 2012 and 2015. Results In 2015, low-income WRA had a significantly lower odds of reporting an unmet dental care need (ORadj = 0.72, 95% CI 0.54, 0.95), unmet vision care need (ORadj = 0.68, 95% CI 0.50, 0.93), unmet mental health need (ORadj = 0.57, 95% CI 0.39, 0.83), and unmet prescription need (ORadj = 0.39, 95% CI 0.45, 0.80) compared to 2012. There were no significant differences in the odds of seeing a doctor or dentist in the past year or of having a usual source of care for low-income WRA in 2012 and 2015. Conclusions for Practice After Ohio’s 2014 Medicaid expansion the odds of low-income WRA having unmet healthcare needs was reduced. Future research should examine outcomes after a longer period of follow-up and include additional measures, such as self-rated health status.
KeywordsMedicaid expansion Unmet health needs Women of reproductive age Affordable Care Act (ACA) Ohio Medicaid Assessment Survey (OMAS)
This study was funded by the Ohio Department of Medicaid and administered by the Ohio Colleges of Medicine Government Resource Center. The views expressed in this manuscript are solely those of the authors and do not represent the views of the state of Ohio or federal Medicaid programs.
- Ali, M. M., Teich, J., Woodward, A., & Han, B. (2016). The implications of the Affordable Care Act for behavioral health services utilization. Administration and Policy in Mental Health and Mental Health Services Research, 43(1), 11–22. https://doi.org/10.1007/s10488-014-0615-8.CrossRefPubMedGoogle Scholar
- Baicker, K., Taubman, S. L., Allen, H. L., Bernstein, M., Gruber, J. H., Newhouse, J. P., … Finkelstein, A. N. (2013). The Oregon experiment—effects of medicaid on clinical outcomes. New England Journal of Medicine, 368(18), 1713–1722. https://doi.org/10.1056/NEJMsa1212321.CrossRefPubMedGoogle Scholar
- Cheong, C., Jung, J. K., Segal, J., & Bhandari, N. (2016, June). The first year evidence on the impact of the ACA on patient experience of provider access among Medicaid enrollees. Presented at the 6th Biennial Conference of the American Society of Health Economists in Philadelphia, PA. Philadelphia, PA: University of Pennsylvania. Retrieved from https://ashecon.confex.com/ashecon/2016/webprogram/Paper3552.html.
- Clemans-Cope, L., Long, S. K., Coughlin, T. A., Yemane, A., & Resnick, D. (2013). The expansion of medicaid coverage under the ACA: Implications for health care access, use, and spending for vulnerable low-income adults. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 50(2), 135–149. https://doi.org/10.1177/0046958013513675.CrossRefPubMedGoogle Scholar
- Early, D., de Bocanegra, T., H., & Schwarz, E. (2016). Increasing coverage is not increasing care: Early data from California. Contraception, 94(4), 390–391. https://doi.org/10.1016/j.contraception.2016.07.034.CrossRefGoogle Scholar
- Finkelstein, A., Taubman, S., Wright, B., Bernstein, M., Gruber, J., & Newhouse, J. P. … Oregon Health Study Group. (2012). The Oregon health insurance experiment: Evidence from the first year. The Quarterly Journal of Economics, 127(3), 1057–1106. https://doi.org/10.1093/qje/qjs020.CrossRefPubMedPubMedCentralGoogle Scholar
- Johnson, K. (2012). Addressing women’s health needs and improving birth outcomes: Results from a peer-to-peer state medicaid learning project. The Commonwealth Fund, 21, 1–19. Retrieved from http://www.commonwealthfund.org/publications/issue-briefs/2012/aug/addressing-womens-health-needs.
- Johnston, E. M., Strahan, A. E., Joski, P., Dunlop, A. L., & Adams, E. K. (2018). Impacts of the Affordable Care Act’s medicaid expansion on women of reproductive age: Differences by parental status and state policies. Womens Health Issues, 28(2), 122–129. https://doi.org/10.1016/j.whi.2017.11.005.CrossRefPubMedGoogle Scholar
- Jones, R. K., & Sonfield, A. (2016). Health insurance coverage among women of reproductive age before and after implementation of the affordable care act. Contraception, 93(5), 386–391. https://doi.org/10.1016/j.contraception.2016.01.003.CrossRefPubMedPubMedCentralGoogle Scholar
- Kaiser Family Foundation. (2018, May 30). Total Monthly Medicaid and CHIP Enrollment. Retrieved from http://kff.org/health-reform/state-indicator/total-monthly-medicaid-and-chip-enrollment/.
- Lantz, P. M., & Soliman, S. (2009). An evaluation of a Medicaid expansion for cancer care: The Breast and Cervical Cancer Prevention and Treatment Act of 2000. Women’s Health Issues: Official Publication of the Jacobs Institute of Women’s Health, 19(4), 221–231. https://doi.org/10.1016/j.whi.2009.04.001.CrossRefGoogle Scholar
- Medicaid.gov. (2017). Medicaid and CHIP eligibility levels. Retrieved June 1, 2018, from https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-eligibility-levels/index.html.
- Ndumele, C. D., Mor, V., Allen, S., Burgess, J. F., & Trivedi, A. N. (2014). Effect of expansions in state Medicaid eligibility on access to care and the use of emergency department services for adult Medicaid enrollees. JAMA Internal Medicine, 174(6), 920–926. https://doi.org/10.1001/jamainternmed.2014.588.CrossRefPubMedPubMedCentralGoogle Scholar
- Ohio Department of Health. (2016, March). Dental health professional shortage areas. Retrieved July 13, 2016, from http://www.ohiodentalclinics.com/hpsa.html.
- Ohio Department of Job and Family Services. (2009). Fact sheet: Healthy start and healthy families. Retrieved June 1, 2018, from https://www.perryjfs.org/pdf/Healthy_Start_Healthy_Families_Fact_Sheet.pdf.
- Ohio Department of Medicaid. (2016, June 6). Report on pregnant women, infants and children. Retrieved June 29, 2016, from http://medicaid.ohio.gov/Portals/0/Resources/Reports/PWIC/PWIC-Report-2015.pdf.
- Ohio Department of Medicaid. (2017). Ohio Medicaid covered services. Retrieved June 1, 2018, from http://medicaid.ohio.gov/FOR-OHIOANS/Covered-Services#1683594-pregnancy.
- Ohio Department of Medicaid Claims Data. (2018). Medicaid eligibility: Pregnant women and post-delivery 2012–2016. Claims data obtained from Ohio Medicaid’s Medicaid Information Technology System (MITS), Business Intelligence and Analytical Research (BIAR) System, Medicaid’s Quality Decision Support System (QDSS), and the Ohio Department of Health Bureau of Vital Statistics.Google Scholar
- Ohio Medicaid Assessment Survey. (2015). 2015 Ohio Medicaid Assessment Survey: Methodology Report. Retrieved November 4, 2016, from http://grc.osu.edu/sites/default/files/inline-files/12015OMASMethReptFinal121115psg.pdf.
- Ohio Medicaid Assessment Survey. (2016a). Ohio Medicaid Assessment Survey. Retrieved January 19, 2017, from http://grc.osu.edu/OMAS.
- Ohio Medicaid Assessment Survey. (2016b). Survey data. Retrieved June 14, 2016, from http://grc.osu.edu/omas/datadownloads/index.cfm.
- Stata. (2016). Data analysis and statistical software. Retrieved May 12, 2016, from http://www.stata.com/.
- U.S. Census Bureau. American Community Survey 2014 (5-year estimates). Prepared by Social Explorer. Retrieved June 14, 2016.Google Scholar