Medicaid Primary Care Utilization and Area-Level Social Vulnerability.

Area of Science:

• Health Services Research
• Socioeconomic Determinants of Health
• Health Equity

Background:

• Poverty concentration limits healthcare access in disadvantaged communities.
• Area-level socioeconomic indexes are increasingly used to address healthcare resource distribution.
• The association between socioeconomic indexes and primary care access remains understudied.

Purpose of the Study:

• To investigate the link between Medicaid primary care utilization and poverty/multidimensional disadvantage at the zip code level.
• To assess the utility of the Social Vulnerability Index (SVI) in identifying primary care access disparities.
• To compare SVI with income-based poverty rates for identifying disparities.

Main Methods:

• Cross-sectional study using 2019 Transformed-Medicaid Statistical Information System data.
• Analysis of primary care visits (including Federally Qualified Health Centers - FQHCs) among Medicaid beneficiaries (<65 years).
• Regression analysis controlling for individual demographics, health conditions, and zip code-level SVI deciles versus poverty rates.

Main Results:

• Over half of 34.8 million beneficiaries lived in the top 20% most socially vulnerable zip codes.
• Beneficiaries in the most vulnerable areas (SVI tenth decile) were less likely to have primary care visits (8.9 pp reduction excluding FQHCs).
• Including FQHC visits mitigated the disparity (4.7 pp reduction), and FQHC use was higher in vulnerable areas (5.9 pp increase).

Conclusions:

• Medicaid policy should address geography-based disparities using multidimensional measures like the SVI.
• The SVI effectively identifies areas with barriers to adequate healthcare access.
• Increased investment in FQHCs is crucial for mitigating geographic inequities in healthcare access.