PHP67 - Examining the Impact of Arkansas Medicaid Expansion Through Premium Purchase on Utilization of Preventative Screening Services

Abstract

Arkansas expanded coverage to poor and near-poor individuals by purchasing coverage in qualified health plans (QHP) for with incomes between 17-138% of federal poverty level instead of traditional Medicaid. This study compared the long-term differences in the receipt of preventive screenings in traditional Medicaid and QHP Newly enrolled individuals, 19-64 years of age with at least 180 days of continuous enrollment with either Medicaid or QHP coverage in two consecutive years between 2014-2016 were analyzed. Two approaches were used to estimate plan differences; 1) a regression discontinuity (RD) design based on a continuous measure of health needs assessed prior to plan enrollment, 2) a matched propensity score (PS) design that utilized demographic and comorbidity information collected in the first year of enrollment utilizing sample not receiving the health needs assessment. The main outcome measures were 1) receipt of any one recommended screening, 2) receipt of all recommended screenings, were based on HEDIS definitions and included annual HbA1c, LDL-c, chlamydia screenings, biennial screenings for colorectal and breast cancer, and triennial cervical cancer screening. There were 73,924 persons in the PS design eligible for at least one screen and 34,783 persons in the RD sample. In the matched PS sample, more persons received at least one of their recommended screens (39.8% vs. 30.2%; p<0.001) and all of their recommended screens (21.1% vs. 16.9%; p<0.001) in QHPs than in Medicaid. In the RD analysis, the proportion of persons receiving any and all of their recommended screens was 15.3% (p<0.001) and 6.9% (p<0.001) higher for QHP than Medicaid. Fewer than quarter of the persons received all their recommended screens, however, enrolling persons in QHP instead of Medicaid appears to improve compliance with preventative screening.