title: Community Health Center Utilization Following the 2008 Medicaid Expansion in Oregon: Implications for the Affordable Care Act.
abstract: OBJECTIVE
  To assess longitudinal patterns of community health center (CHC) utilization and the effect of insurance discontinuity after Oregon's 2008 Medicaid expansion (the Oregon Experiment).
  
  
  METHODS
  We conducted a retrospective cohort study with electronic health records and Medicaid data. We divided individuals who gained Medicaid in the Oregon Experiment into those who maintained (n = 788) or lost (n = 944) insurance coverage. We compared these groups with continuously insured (n = 921) and continuously uninsured (n = 5416) reference groups for community health center utilization rates over a 36-month period.
  
  
  RESULTS
  Both newly insured groups increased utilization in the first 6 months. After 6 months, use among those who maintained coverage stabilized at a level consistent with the continuously insured, whereas it returned to baseline for those who lost coverage.
  
  
  CONCLUSIONS
  Individuals who maintained coverage through Oregon's Medicaid expansion increased long-term utilization of CHCs, whereas those with unstable coverage did not.
  
  
  CONCLUSIONS
  This study predicts long-term increase in CHC utilization following Affordable Care Act Medicaid expansion and emphasizes the need for policies that support insurance retention.
authors.affiliation: Brigit Hatch, Steffani R. Bailey, Miguel Marino, Heather Angier, and Jennifer E. DeVoe are with Oregon Health and Science University, Portland. Stuart Cowburn and Jennifer E. DeVoe are with OCHIN, Portland.
authors.forename: Brigit
authors.initials: B
authors.lastname: Hatch
authors.affiliation: Brigit Hatch, Steffani R. Bailey, Miguel Marino, Heather Angier, and Jennifer E. DeVoe are with Oregon Health and Science University, Portland. Stuart Cowburn and Jennifer E. DeVoe are with OCHIN, Portland.
authors.forename: Steffani R
authors.initials: SR
authors.lastname: Bailey
authors.affiliation: Brigit Hatch, Steffani R. Bailey, Miguel Marino, Heather Angier, and Jennifer E. DeVoe are with Oregon Health and Science University, Portland. Stuart Cowburn and Jennifer E. DeVoe are with OCHIN, Portland.
authors.forename: Stuart
authors.initials: S
authors.lastname: Cowburn
authors.affiliation: Brigit Hatch, Steffani R. Bailey, Miguel Marino, Heather Angier, and Jennifer E. DeVoe are with Oregon Health and Science University, Portland. Stuart Cowburn and Jennifer E. DeVoe are with OCHIN, Portland.
authors.forename: Miguel
authors.initials: M
authors.lastname: Marino
authors.affiliation: Brigit Hatch, Steffani R. Bailey, Miguel Marino, Heather Angier, and Jennifer E. DeVoe are with Oregon Health and Science University, Portland. Stuart Cowburn and Jennifer E. DeVoe are with OCHIN, Portland.
authors.forename: Heather
authors.initials: H
authors.lastname: Angier
authors.affiliation: Brigit Hatch, Steffani R. Bailey, Miguel Marino, Heather Angier, and Jennifer E. DeVoe are with Oregon Health and Science University, Portland. Stuart Cowburn and Jennifer E. DeVoe are with OCHIN, Portland.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: DeVoe
mesh_terms: D000293:Adolescent; D000328:Adult; D003151:Community Health Centers / Q000706:statistics & numerical data* / Q000639:trends; D057286:Electronic Health Records; D006297:Health Services Accessibility; D006801:Humans; D019458:Insurance Coverage / Q000639:trends; D007348:Insurance, Health / Q000191:economics; D008297:Male; D008484:Medicaid / Q000331:legislation & jurisprudence*; D017057:Medically Uninsured; D008875:Middle Aged; D009922:Oregon; D058991:Patient Protection and Affordable Care Act; D012189:Retrospective Studies; D014481:United States