title: State medicaid coverage, ESRD incidence, and access to care.
abstract: The proportion of low-income nonelderly adults covered by Medicaid varies widely by state. We sought to determine whether broader state Medicaid coverage, defined as the proportion of each state's low-income nonelderly adult population covered by Medicaid, associates with lower state-level incidence of ESRD and greater access to care. The main outcomes were incidence of ESRD and five indicators of access to care. We identified 408,535 adults aged 20-64 years, who developed ESRD between January 1, 2001, and December 31, 2008. Medicaid coverage among low-income nonelderly adults ranged from 12.2% to 66.0% (median 32.5%). For each additional 10% of the low-income nonelderly population covered by Medicaid, there was a 1.8% (95% confidence interval, 1.0% to 2.6%) decrease in ESRD incidence. Among nonelderly adults with ESRD, gaps in access to care between those with private insurance and those with Medicaid were narrower in states with broader coverage. For a 50-year-old white woman, the access gap to the kidney transplant waiting list between Medicaid and private insurance decreased by 7.7 percentage points in high (>45%) versus low (<25%) Medicaid coverage states. Similarly, the access gap to transplantation decreased by 4.0 percentage points and the access gap to peritoneal dialysis decreased by 3.8 percentage points in high Medicaid coverage states. In conclusion, states with broader Medicaid coverage had a lower incidence of ESRD and smaller insurance-related access gaps.
authors.affiliation: Geriatrics Research Education & Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Division of Nephrology and mktamura@stanford.edu.
authors.forename: Manjula
authors.initials: M
authors.lastname: Kurella-Tamura
authors.affiliation: Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Palo Alto, California; and.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Goldstein
authors.affiliation: Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, Washington.
authors.forename: Yoshio N
authors.initials: YN
authors.lastname: Hall
authors.affiliation: Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Palo Alto, California; and.
authors.forename: Aya A
authors.initials: AA
authors.lastname: Mitani
authors.affiliation: Division of Nephrology and.
authors.forename: Wolfgang C
authors.initials: WC
authors.lastname: Winkelmayer
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000191:economics / Q000453:epidemiology; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007348:Insurance, Health / Q000706:statistics & numerical data; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000453:epidemiology* / Q000628:therapy; D016030:Kidney Transplantation / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008875:Middle Aged; D011203:Poverty / Q000191:economics / Q000706:statistics & numerical data; D012042:Registries / Q000706:statistics & numerical data; D006435:Renal Dialysis / Q000191:economics / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult