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Maternal and Child Health Journal

, Volume 22, Issue 12, pp 1771–1779 | Cite as

Ohio’s Medicaid Expansion and Unmet Health Needs Among Low-Income Women of Reproductive Age

  • Thalia P. Farietta
  • Bo Lu
  • Rachel Tumin
Article
  • 89 Downloads

Abstract

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.

Keywords

Medicaid expansion Unmet health needs Women of reproductive age Affordable Care Act (ACA) Ohio Medicaid Assessment Survey (OMAS) 

Notes

Acknowledgements

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.

References

  1. Adams, E. K., Gavin, N. I., Handler, A., Manning, W., & Raskind-Hood, C. (2003). Transitions in insurance coverage from before pregnancy through delivery in nine states, 1996–1999. Health Affairs (Project Hope), 22(1), 219–229.CrossRefGoogle Scholar
  2. Adams, E. K., Kenney, G. M., & Galactionova, K. (2013). Preventive and reproductive health services for women: The role of California’s family planning waiver. American Journal of Health Promotion: AJHP, 27(3 Suppl), eS1–eS10.  https://doi.org/10.4278/ajhp.120113-QUAN-28.CrossRefPubMedGoogle Scholar
  3. 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
  4. 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
  5. Benitez, J. A., Creel, L., & Jennings, J. (2016). Kentuckys Medicaid expansion showing early promise on coverage and access to care. Health Affairs, 35(3), 528–534.  https://doi.org/10.1377/hlthaff.2015.1294.CrossRefPubMedGoogle Scholar
  6. 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.
  7. 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
  8. Decker, S. L. (2012). In 2011 nearly one-third of physicians said they would not accept new medicaid patients, but rising fees may help. Health Affairs, 31(8), 1673–1679.  https://doi.org/10.1377/hlthaff.2012.0294.CrossRefPubMedGoogle Scholar
  9. 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
  10. Fingar, K. R., Smith, M. W., Davies, S., McDonald, K. M., Stocks, C., & Raven, M. C. (2015). Medicaid dental coverage alone may not lower rates of dental emergency department visits. Health Affairs, 34(8), 1349–1357.  https://doi.org/10.1377/hlthaff.2015.0223.CrossRefPubMedGoogle Scholar
  11. 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
  12. Flynn, P., Call, K. T., Pintor, J. K., & Elmi, N. (2014). The projected effect of the Affordable Care Act on dental care for adult Medicaid enrollees. Journal of Health Care for the Poor and Underserved, 25(1 Suppl), 79–94.  https://doi.org/10.1353/hpu.2014.0059.CrossRefPubMedGoogle Scholar
  13. Han, X., Nguyen, B. T., Drope, J., & Jemal, A. (2016). Health-related outcomes among the poor: Medicaid expansion vs. non-expansion states. PLoS ONE, 10(12), e0144429.  https://doi.org/10.1371/journal.pone.0144429.CrossRefGoogle Scholar
  14. 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.
  15. 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
  16. 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
  17. 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/.
  18. Keating, N. L., Kouri, E. M., He, Y., West, D. W., & Winer, E. P. (2013). Effect of Massachusetts health insurance reform on mammography use and breast cancer stage at diagnosis. Cancer, 119(2), 250–258.  https://doi.org/10.1002/cncr.27757.CrossRefPubMedGoogle Scholar
  19. 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
  20. 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.
  21. 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
  22. Ohio Department of Health. (2016, March). Dental health professional shortage areas. Retrieved July 13, 2016, from http://www.ohiodentalclinics.com/hpsa.html.
  23. 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.
  24. 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.
  25. Ohio Department of Medicaid. (2017). Ohio Medicaid covered services. Retrieved June 1, 2018, from http://medicaid.ohio.gov/FOR-OHIOANS/Covered-Services#1683594-pregnancy.
  26. 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
  27. 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.
  28. Ohio Medicaid Assessment Survey. (2016a). Ohio Medicaid Assessment Survey. Retrieved January 19, 2017, from http://grc.osu.edu/OMAS.
  29. Ohio Medicaid Assessment Survey. (2016b). Survey data. Retrieved June 14, 2016, from http://grc.osu.edu/omas/datadownloads/index.cfm.
  30. Ranji, U., & Salganicoff, A. (2015). Medicaid and women’s health coverage two years into the Affordable Care Act. Women’s Health Issues, 25(6), 604–607.  https://doi.org/10.1016/j.whi.2015.08.008.CrossRefPubMedGoogle Scholar
  31. Sommers, B. D., Arntson, E., Kenney, G., & Epstein, A. (2013). Lessons from early medicaid expansions under health reform: Interviews with medicaid officials. Medicare & Medicaid Research Review, 3(4), E1–E23.  https://doi.org/10.5600/mmrr.003.04.a02.CrossRefGoogle Scholar
  32. Sommers, B. D., Baicker, K., & Epstein, A. M. (2012). Mortality and access to care among adults after state Medicaid expansions. The New England Journal of Medicine, 367(11), 1025–1034.  https://doi.org/10.1056/NEJMsa1202099.CrossRefPubMedGoogle Scholar
  33. Sommers, B. D., Kenney, G., & Epstein, A. (2016). New evidence on The Affordable Care Act: Coverage impacts of early medicaid expansions. Health Affairs, 33(1), 78–87.CrossRefGoogle Scholar
  34. Stata. (2016). Data analysis and statistical software. Retrieved May 12, 2016, from http://www.stata.com/.
  35. U.S. Census Bureau. American Community Survey 2014 (5-year estimates). Prepared by Social Explorer. Retrieved June 14, 2016.Google Scholar
  36. Wherry, L. R., & Miller, S. (2016). Early coverage, access, utilization, and health effects associated with the affordable care act medicaid expansions: A quasi-experimental study. Annals of Internal Medicine, 164(12), 795.  https://doi.org/10.7326/M15-2234.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Center for Outcomes Research and EvaluationYale UniversityNew HavenUSA
  2. 2.The Ohio State University College of Public HealthColumbusUSA
  3. 3.Ohio Colleges of Medicine Government Resource CenterColumbusUSA

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