Capstone 2011 Kisha Davis, M.D.

 Created in 1965 to provide medical coverage to the poor  Children, the disabled, pregnant women, very low income parents and the elderly poor are eligible  Federally funded, state administered  Income limits range from 17% (AK) to 215% (MN) of FPL

 In 2007 Maryland passed the Working Families and Small Business Health Coverage Act  The Medical Assistance to Families program increased Medicaid eligibility for parents from 36% to 116% (FPL)  Covered an additional 65,000 people  Similar to the coming Affordable Care Act Medicaid expansion

 The purpose of this study is to examine the characteristics of the expansion population in comparison to the non-expansion population to determine if there are differences in health care costs and utilization. ◦ Sicker or healthier? ◦ More expensive or less? ◦ Pent up demand?

 Claims data from a Managed Care Organization (MCO) FY 2009 & 2010  Newly enrolled individuals aged 19 to 64  Remained enrolled for at least six months  Study groups ◦ Expansion ◦ Previously Eligible ◦ Continuous- enrolled last 6 months of FY 2008

 Identified by the state as expansion or not  Excluded disabled persons, pregnant women, persons with substance abuse diagnosis  Each member followed for maximum of 12 months after start of experience period

Categorical variables: chi-square Continuous Variables: ANOVA with Tukey’s test for adjustment for multiple comparison Multivariate analysis done using proc genmod All analyses done in SAS

Expansion (N = 13,987) Previously Eligible (N=7,922) Continuously Enrolled (N= 1,159) P-Value Mean months enrolled (SD) p < for all Mean age (SD) E v P p < E v C p= P v C p= Female, %71.4%74.2%82.1%p < Race, % White37.2%33.0%33.1%p < Black/Hispanic/ Asian/Indian 40.2%46.5%61.9% Unknown22.6%20.5%5.1% Region*, % Urban14.0%21.6%33.7%p < Suburban38.6%42.1%35.0% Rural47.4%36.4%31.3%

Expansion (N = 13,987) Previously Eligible (N=7,922) Continuously Enrolled (N= 1,159) P-Value Number of Chronic Conditions p < %64.2%46.1% 117.7%17.2%21.7% 29.1%8.3%12.7% %10.3%19.6% Mean ACG- (prob. of being high cost in the next year) E v P p= E v C p< P v C p < RUB Score (morbidity)p < Non-users11.7%14.6%11.0% Very low12.2%12.3%4.5% Low12.7%12.0%10.4% Moderate44.1%40.9%45.5% High15.2%15.9%19.3% Very high4.2%4.3%9.2%

Mean Total Costs Mean Inpatient Costs

Regression Analysis P-Value Expansion0 Previously Eligible $55P< Continuous-$74P=0.0001

 Limitations ◦ Time frame continuous vs newly enrolled ◦ Drop outs  Implications for Affordable Care Act ◦ Predictions on health status of new enrollees ◦ Cost considerations ◦ Continuous coverage  Future Directions

 Dr. Jonathan Weiner  Alyson Schuster  Dr. Peter Fagan  Priority Partners

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