Affiliation:
1. Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center Veterans Health Administration, U.S. Department of Veterans' Affairs Houston Texas USA
2. Section for Health Services Research, Department of Medicine Baylor College of Medicine Houston Texas USA
Abstract
AbstractObjectiveTo evaluate changes in dual enrollment after Affordable Care Act Medicaid expansion by VA priority group, (e.g., service connection), sex, and type of state expansion.Study SettingOur cohort was all Veterans ages 18–64 enrolled in VA and eligible for benefits due to military service‐connection or low income from 2011 to 2016; the unit of analysis was person‐year.Study DesignDifference‐in‐difference and event‐study analysis. The outcome was dual VA‐Medicaid enrollment for at least 1 month annually. Medicaid expansion, VA priority status, whether a state expanded by a Section 1115 waiver, and sex were independent variables. We controlled for race, ethnicity, age, disease burden, distance to VA facilities, state, and year.Data Extraction MethodsWe used data from the VA Corporate Data Warehouse (CDW) regarding age and VA Priority Group to select our cohort of VA‐enrolled individuals. We then took the cohort and crossed checked it with Medicaid Analytic Extract (MAX) and T‐MSIS Analytic Files (TAF) to determine Medicaid enrollment status.Principal FindingsService‐connected Veterans experienced lower dual‐enrollment increases across all sex and state‐waiver groups (3.44 percentage points (95% CI: 1.83, 5.05 pp) for women, 3.93 pp (2.98, 4.98) for men, 4.06 pp (2.85, 5.27) for non‐waiver states, and 3.00 pp (1.58 to 4.41) for waiver states) than Veterans who enrolled in the VA due to low income (8.19 pp (5.43, 10.95) for women, 9.80 pp (7.06, 12.54) for men, 10.21 pp (7.17, 13.25) for non‐waiver states, and 7.39 pp (5.28, 9.50) for waiver states).ConclusionsMedicaid expansion is associated with dual enrollment. Dual‐enrollment changes are greatest in those enrolled in the VA due to low income, but do not differ by sex or expansion type. Results can help VA identify groups disproportionately likely to have potential care‐coordination issues due to usage of multiple health care systems.