Effect of Medicaid Expansion on Visit Composition in a Louisiana Health Care System

Background: In 2016, Louisiana expanded Medicaid to low-income adults under the Patient Protection and Affordable Care Act. By 2020, the uninsured rate of adults in Louisiana had dropped from 22.7% to 8.9%; however, few reports describe the effect Medicaid expansion has had on access and utilization of health care services in Louisiana. Methods: For this study, we collected all-payer emergency department and clinic visits from one health care system in Louisiana from 2015 to 2019. We used a time series analysis to compare trends before and after Medicaid expansion in health insurance coverage and emergency department visit type. Results: The changes in payer mix in the urgent care and primary care clinics and emergency departments after Medicaid expansion was driven by the uptake of Medicaid coverage in the previously uninsured. Medicaid expansion had a limited impact on the number of urgent care and emergent and nonemergent emergency department visits, but an increase in primary care visits was observed. Conclusion: Medicaid expansion reduced uncompensated care in our patient population and expanded the access to primary care clinics. Ongoing research is needed to understand the effect of nonfinancial barriers to care on access to and utilization of services in Louisiana.