Interruptions in Medicaid coverage and risk for hospitalization for ambulatory care-sensitive conditions.
BACKGROUND
Many low-income U.S. citizens experience interruptions in health insurance coverage.


OBJECTIVE
To determine the rate of hospitalization for ambulatory care-sensitive conditions among Medicaid beneficiaries with interruptions in coverage.


METHODS
Retrospective cohort study.


METHODS
California Medicaid population.


METHODS
4,735,797 adults in California age 18 to 64 years who received a minimum of 1 month of Medicaid coverage between 1998 to 2002.


METHODS
Time to hospitalization for an ambulatory care-sensitive condition.


RESULTS
Sixty-two percent of Medicaid beneficiaries experienced at least 1 interruption in coverage during the study period. The 3 most common ambulatory care-sensitive conditions resulting in a hospitalization were heart failure, diabetes, and chronic obstructive pulmonary disease. Interruptions in coverage were associated with a higher risk for hospitalization for an ambulatory care-sensitive condition (adjusted hazard ratio, 3.66 [95% CI, 3.59 to 3.72]; P < 0.001). In subgroup analyses, the association between interrupted coverage and hospitalization was stronger for beneficiaries eligible through the Temporary Aid to Needy Families program (adjusted hazard ratio, 8.56 [CI, 8.06 to 9.08]) than for beneficiaries eligible through the Supplemental Security Income program (adjusted hazard ratio, 1.72 [CI, 1.67 to 1.76]), who typically retain Medicare coverage even when their Medicaid coverage is interrupted.


CONCLUSIONS
The study lacked information on why interruptions occurred and whether beneficiaries with interruptions transitioned to other insurance coverage.


CONCLUSIONS
Interruptions in Medicaid coverage are associated with a higher rate of hospitalization for ambulatory care-sensitive conditions. Policies that reduce the frequency of interruptions in Medicaid coverage might prevent some of the health events that trigger hospitalization and high-cost health care spending.
Bindman
Andrew B
AB
San Francisco General Hospital and University of California, San Francisco, San Francisco, California 94110, USA. abindman@medsfgh.ucsf.edu
Chattopadhyay
Arpita
A
Auerback
Glenna M
GM
D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000191:economics*; D002140:California; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D019458:Insurance Coverage / Q000191:economics*; D008297:Male; D008484:Medicaid / Q000191:economics*; D008875:Middle Aged; D011203:Poverty / Q000191:economics; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014481:United States; D055815:Young Adult