Primary care for new vs established Medicaid enrollees

Area of Science:

• Health Services Research
• Public Health Policy
• Healthcare Access

Background:

• The Affordable Care Act (ACA) aimed to expand health insurance coverage.
• Understanding changes in primary care (PC) utilization among Medicaid and Children's Health Insurance Program (CHIP) beneficiaries post-ACA is crucial.

Purpose of the Study:

• To analyze shifts in PC utilization within Medicaid and CHIP programs three years after the ACA's implementation.
• To compare PC visit trends for newly enrolled and established patients before and after the ACA.

Main Methods:

• Utilized secondary data from Medicaid/CHIP paid claims and managed care encounters.
• Analyzed pre-/post-ACA trends in enrollment and PC visits in half-year increments from 2012 to 2016.
• Examined newly enrolled and established patient cohorts separately.

Main Results:

• Medicaid/CHIP experienced an initial surge in new enrollment post-ACA, followed by steady growth.
• New enrollees' PC visit rates initially dropped post-ACA but later recovered to pre-ACA levels.
• Established enrollees showed a declining trend in PC visits per person after the ACA.

Conclusions:

• The ACA led to increased Medicaid/CHIP enrollment, with initial PC access challenges for new enrollees.
• New enrollees' PC utilization rates eventually matched pre-ACA levels.
• Declining PC utilization among established enrollees suggests potential service delivery bottlenecks or shifting care patterns.