Contextual Factors Influencing the Association Between the Affordable Care Act’s Medicaid Expansion and Veteran VA-Medicaid Dual Enrollment

Authors

Patrick N O'Mahen
Chase S Eck
Cheng Rebecca Jiang
Laura A Petersen

Language

English

Publication Date

6-1-2024

Journal

Health Services Research

DOI

10.1111/1475-6773.14280

PMID

38258310

PMCID

PMC11063093

PubMedCentral® Posted Date

1-22-2024

PubMedCentral® Full Text Version

Post-print

Abstract

Objective: To evaluate changes in dual enrollment after Affordable Care Act Medicaid expansion by VA priority group, (e.g., service connection), sex, and type of state expansion.

Study setting: Our cohort was all Veterans ages 18-64 enrolled in VA and eligible for benefits due to military service-connection or low income from 2011 to 2016; the unit of analysis was person-year.

Study design: Difference-in-difference and event-study analysis. The outcome was dual VA-Medicaid enrollment for at least 1 month annually. Medicaid expansion, VA priority status, whether a state expanded by a Section 1115 waiver, and sex were independent variables. We controlled for race, ethnicity, age, disease burden, distance to VA facilities, state, and year.

Data extraction methods: We used data from the VA Corporate Data Warehouse (CDW) regarding age and VA Priority Group to select our cohort of VA-enrolled individuals. We then took the cohort and crossed checked it with Medicaid Analytic Extract (MAX) and T-MSIS Analytic Files (TAF) to determine Medicaid enrollment status.

Principal findings: Service-connected Veterans experienced lower dual-enrollment increases across all sex and state-waiver groups (3.44 percentage points (95% CI: 1.83, 5.05 pp) for women, 3.93 pp (2.98, 4.98) for men, 4.06 pp (2.85, 5.27) for non-waiver states, and 3.00 pp (1.58 to 4.41) for waiver states) than Veterans who enrolled in the VA due to low income (8.19 pp (5.43, 10.95) for women, 9.80 pp (7.06, 12.54) for men, 10.21 pp (7.17, 13.25) for non-waiver states, and 7.39 pp (5.28, 9.50) for waiver states).

Conclusions: Medicaid expansion is associated with dual enrollment. Dual-enrollment changes are greatest in those enrolled in the VA due to low income, but do not differ by sex or expansion type. Results can help VA identify groups disproportionately likely to have potential care-coordination issues due to usage of multiple health care systems.

Keywords

Humans, United States, Medicaid, Patient Protection and Affordable Care Act, Male, Female, Middle Aged, Adult, United States Department of Veterans Affairs, Veterans, Adolescent, Young Adult, Sex Factors, Poverty, Insurance Coverage, affordable care act, Medicaid, Medicaid waivers, Veterans Health Administration, women

Published Open-Access

yes

Recommended Citation

O'Mahen, Patrick N; Eck, Chase S; Jiang, Cheng Rebecca; et al., "Contextual Factors Influencing the Association Between the Affordable Care Act’s Medicaid Expansion and Veteran VA-Medicaid Dual Enrollment" (2024). Center for Medical Ethics and Health Policy Staff Publications. 256.
https://digitalcommons.library.tmc.edu/med_ethics/256