ACA-Funded Medicaid Expansion Increased LTC Use

According to new research published online in JAMA Network Open, long-term care (LTC) use among newly eligible low-income, middle-aged adults increased following the expansion of Medicaid.

“Medicaid expansion is associated with increased access to health services, increased quality of medical care delivered, and reduced mortality, but little is known about its association with use of LTC,” the study authors wrote.  

In order to examine and understand the link between Medicaid expansion under the Patient Protection and Affordable Care Act (ACA) with LTC use, a team of researchers conducted a difference-in-difference cohort study. Using Health and Retirement Study data, they surveyed participants aged 50 years or older. They then compared LTC use from 2008 to 2012 with use from 2014 to 2016 among low-income adults aged 50 to 64 years without Medicare coverage residing in states in which Medicaid coverage expanded in 2014 and those living in states without expansion. Of important note, the researchers included low-income adults who were covered by Medicare and were ineligible for expanded Medicaid.  

The research team identified 891 adults who were eligible for expanded Medicaid. The mean (SD) age was 55.2 (3.1) years, there were 534 (53.4%) women, 482 (49.5%) were married, and 661 (45.9%) were White non-Hispanic. 

“Before the ACA-funded Medicaid expansion, 0.4% (95% CI, −0.3% to 1.1%) in expansion states and 1.0% (95% CI, −0.1% to 2.2%) in nonexpansion states used nursing homes, and 1.9% (95% CI, 0.4%-3.4%) in expansion states and 7.1% (95% CI, 4.7%-9.5%) in nonexpansion states used any formal home care,” they wrote.

The findings showed that the ACA-funded Medicaid expansion increased 4.4 percentage points (95% CI, 2.8-6.1 percentage points) in the probability of any LTC use among low-income, middle-aged adults. Of note, increases in home health use (3.8 percentage points; 95% CI, 2.0-5.6 percentage points) and in any nursing home use (2.1 percentage points; 95% CI, 0.9-3.3 percentage points) were observed 

“In this study, ACA-funded Medicaid expansion was associated with an increase in
any long-term care use among newly eligible low-income, middle-aged adults, suggesting that the population covered by the Medicaid expansion may have had unmet long-term care needs before expansion,” they concluded. —Julie Gould