Does Medicaid Expansion Improve Access to Care for Ankle Sprains?

Abstract

Category:Ankle; Sports; OtherIntroduction/Purpose:Prior research has found Medicaid patients face greater difficulty scheduling appointments with orthopaedic surgeons compared to those with other insurance. Recently, a number of states have expanded Medicaid coverage as part of the affordable care act, although it is unclear how this expansion impacts the ability of these patients to obtain access to orthopaedic surgeons. We questioned whether Medicaid patients face additional barriers to care for treatment of ankle sprains, an extremely common athletic injury. Our goal was to determine whether individual state Medicaid expansion status, as well as type of insurance accepted, affected access to care for ankle sprains.Methods:Four pairs of Medicaid expanded (Kentucky, Louisiana, Iowa, Arizona) and unexpanded (North Carolina, Alabama, Wisconsin, Texas) states in similar geographic locations were chosen. Twelve foot and ankle practices from each state (N=96) were randomly selected from the American Orthopaedic Foot & Ankle Society directory. Each clinic was called twice to request an appointment for a fictitious 16-year-old with a first-time ankle sprain with either in-state Medicaid insurance or Blue Cross Blue Shield (BCBS) private insurance.Results:An appointment was obtained at 63 (65.6%) clinics when calling with BCBS and 44 (45.8%) clinics with Medicaid (P=.006). There was a significant difference in appointment scheduling based on insurance status in Medicaid unexpanded states (Medicaid=21, 43.8% vs. BCBS=34, 70.8%; P=.007). However, this difference was not significant in Medicaid expanded states (Medicaid=23, 47.9% vs. BCBS=29, 60.4%; P=.219). In addition, in all states except Iowa, a Medicaid expanded state, more appointments were scheduled using BCBS than Medicaid. The three most common reasons for appointment denial were inability to provide an insurance identification number (47.1%), insurance status (23.5%), and lack of referral (17.6%). The waiting period for an appointment was not significantly different depending on insurance status or Medicaid expansion status (Medicaid=3.30 days, BCBS=3.43 days, P=.152).Conclusion:For patients with first-time ankle sprains, access to care is more difficult using Medicaid insurance rather than private insurance, especially in Medicaid unexpanded states. However, when granted an appointment, Medicaid patients waited a comparable amount of time to the appointment as those using private insurance.