Medicaid Expansion Research Articles

Impact of Medicaid Policies on Pre-pregnancy Preventive Dental Care.

Dental care before pregnancy is critical for preventing poor oral health, which is associated with adverse pregnancy outcomes. People with low incomes, however, may face insurance-related barriers to obtaining dental care. Medicaid expansion under the Affordable Care Act increased access to dental care utilization among adults with low incomes. However, little is known about the impact of Medicaid policies on pre-pregnancy dental care utilization. To evaluate the impacts on pre-pregnancy dental care utilization of two aspects of Medicaid policy: (1) state level of Medicaid dental coverage and (2) Medicaid expansion overall and by state level of dental coverage. We used data from Pregnancy Risk Assessment Monitoring System (PRAMS) data phases 7 (2012-15) and 8 (2016-18). To examine the association between state level of dental coverage beyond emergency services (i.e., extensive vs. limited) and pre-pregnancy dental care utilization, we conducted an adjusted logistic regression analysis. To evaluate the impact of Medicaid expansion on pre-pregnancy dental care utilization, we conducted a quasi-experimental event study design, which estimates the percentage point difference in the outcome between expansion and non-expansion states at each time period compared to the period just prior to Medicaid expansion. We found a significant 13% (adjusted odds ratio (OR) = 1.13; 95% CI: 1.05, 1.22) higher odds of pre-pregnancy dental care utilization among the birthing people residing in states that provided extensive dental coverage compared to those in states that provided limited dental coverage. However, Medicaid expansion under the ACA was not associated with pre-pregnancy dental care utilization overall or among either states with extensive or limited Medicaid dental coverage.

Medicaid Expansion and Survival Outcomes Among Men With Prostate Cancer.

Prostate cancer stands as one of the most diagnosed malignancies among men worldwide. With the recent expansion of Medicaid under the Affordable Care Act (ACA), millions more Americans now have health insurance coverage, potentially influencing healthcare access and subsequent outcomes for various illnesses, including prostate cancer. Yet, the direct correlation between Medicaid expansion and cancer-specific survival among individuals with prostate cancer remains an area warranting comprehensive exploration. This study aims to determine the impact of the implementation of Medicaid expansion on survival outcomes among men with prostate cancer. We utilized data from the Surveillance, Epidemiology, and End Results (SEER) registry to determine the causal impact of the implementation of the ACA on outcomes among men with prostate cancer. The study covered the years 2003-2021, divided into pre-ACA (2003-2009) and post-ACA (2015-2021) periods, with a one-year washout (2014-2015) since Medicaid expansion was implemented in 2014 in Kentucky.Using a difference-in-differences (DID) approach, we compared survival among men with prostate cancers from Kentucky to Georgia. We adjusted for patient demographics, income, metropolitan status, disease stage, and treatment modalities. We analyzed a cohort of 68,222 men with prostate cancer during the study period. Of these, 37,810 (55.4%) were diagnosed in the pre-ACA period, with 70.8% from Georgia and 29.2% from Kentucky. The remaining 30,412 (44.6%) were diagnosed in the post-ACA period, with 72.3% from Georgia and 27.7% from Kentucky. Medicaid expansion in Kentucky was associated with a 16.8% reduction in the hazard of overall death, indicating improved overall survival among eligible individuals. This trend was consistent across different racial and ethnic groups. Specifically, non-Hispanic White men experienced a 16.2% reduction (DID=-16.2%; 95% CI: -31.5% to -0.8%), non-Hispanic Black men had a 17.9% reduction (DID=-17.9%; 95% CI: -34.8% to -0.9%), and Hispanic men saw a 15.9% reduction (DID=-15.9%; 95% CI: -31.3% to -0.5%) in hazard of death among low-income individuals. Medicaid expansion was associated with a substantive improvement in overall survival among men with prostate cancerin Kentucky compared to non-expansion Georgia.

Medicaid Expansion Increases Treatment for Patients with Colon Cancer.

Medicaid expansion (ME) has positively impacted colon cancer screening. ME's effect on colon cancer treatment is less clear. This study analyses the effect of ME on patterns of colon cancer treatment. Patients with primary invasive colon cancer were identified using the Louisiana Tumor Registry. Patients diagnosed with colon cancer prior to ME (2014-2015) were compared to those diagnosed after (2017-2018). Coordinate variables were analyzed using Fisher's exact test. Treatment status was modeled with multivariable logistic regression and the results are reported as adjusted odds ratios. The proportion of uninsured patients decreased following ME (5.5 versus 1.9, p < 0.001), with the greatest reductions among patients between 45 and 54 years old (13.5% to 3.5%, p < 0.0001), African Americans (8.9 to 2.1%, p < 0.0001), and those in high-poverty neighborhoods (7.1 to 2.1%, p < 0.0001). Following ME, all patients with Stage I-III disease were more likely to receive surgery (OR = 1.95; 95%: CI 1.21-3.14)-especially the extremely impoverished (OR = 2.39; 95% CI 1.41-4.02). Young patients with Stage IV colon cancer were more likely to receive chemotherapy (OR-1.6; 95% CI 1.03-2.4). Patients with Stage IV colon cancer were less likely to receive treatment within 30 days of diagnosis (OR = 0.7; 95% CI 0.5-0.9), but, on subset analysis, this was only observed in non-Medicaid patients. ME is associated with increased treatment for patients with colon cancer, and it did not appear to affect time to treatment. However, it seems to affect different subsets of the population differently.

Evidence for Public Policies to Prevent Suicide Death in the United States.

Suicide rates have increased in the United States in recent years. Public policies have great potential to prevent suicide death, and well-designed quasi-experimental studies have identified policies that are effective at reducing suicide rates; however, evidence about these policies has not been synthesized. This review summarizes evidence across three domains of public policies: (a) policies that affect structural determinants of suicide risk (e.g., policies that improve economic security), (b) policies that promote access to clinical services (e.g., Medicaid expansion), and (c) policies that limit access to lethal means for completing suicide (e.g., policies that restrict access to firearms). The historical context of suicide prevention in US public policy is provided, considerations for successful suicide prevention policy implementation are discussed-such as policy awareness among key groups, enforcement, and sufficient funding-and priority areas for future research are enumerated.

Health Care Utilization and Costs for Older Adults Aging Into Medicare After the Affordable Care Act

The Affordable Care Act (ACA) expanded Medicaid and Marketplace insurance to nonelderly adults in 2014, but whether these policies improved outcomes later in life is unknown. To examine whether exposure to ACA expansions during middle age (50-64 years) was associated with changes in health, utilization, and spending after these adults entered Medicare at 65 years of age. This serial analysis of the Health and Retirement Study cohort linked to Medicare enrollment and claims data from January 1, 2010, to December 31, 2018. Adults aged 65 to 68 years entering Medicare after the ACA (exposed to ACA expansions during middle age) were compared with adults entering Medicare before the ACA (4452 person-years). Interrupted time series analyses were used to assess overall changes associated with exposure to ACA expansions and difference-in-differences analyses to isolate changes associated with Medicaid expansion among low-income adults (incomes ≤400% of the federal poverty level for any ACA coverage and ≤138% for Medicaid expansion coverage). Data were analyzed from March 1, 2023, to May 1, 2024. ACA coverage expansion overall in 2014 and Medicaid expansion as of 2018. Health (self-reported overall, activities of daily living [ADL], instrumental ADL, and depressive symptoms), utilization (outpatient visits, emergency department visits, and hospital admission), and costs (self-reported out-of-pocket and Medicare costs). Among the analytic sample of 2782 participants (mean age, 66.4 [95% CI, 66.3-66.5] years), a weighted 59.1% (95% CI, 55.3%-62.7%) were female. In interrupted time series analyses, reductions across cohorts were found in use of chronic disease medications (-5.0 [95% CI, -9.8 to -0.3] percentage points), hospitalizations per year (-0.2 [95% CI, -0.4 to -0.03]), and out-of-pocket costs (-$417 [95% CI, -$694 to -$139]) but no significant changes across cohorts in health status, outpatient or emergency visits, or Medicare costs. In difference-in-differences analyses relative to nonexpansion states, greater reductions were found in the number of ADL limitations (-0.4 [95% CI, -0.8 to -0.02]) and lesser reductions in out-of-pocket costs ($900 [95% CI, $275-$1526]) in Medicaid expansion states but otherwise similar changes in other outcomes. This study found modest evidence of reductions in out-of-pocket costs and improvements in health among adults entering Medicare after the ACA. Insurance coverage and financial assistance should be preserved and enhanced to improve health and health care access among vulnerable older adults.

Not enough: Medicaid expansion, medical debt, and cost avoidance in rural American Indian and Alaska Native households.

Despite expanding health insurance coverage under the Patient Protection and Affordable Care Act (ACA), many Americans struggle with financial barriers to health care. Medicaid expansion was meant to help alleviate these barriers, particularly for rural communities, but has shown mixed results. The American Indian and Alaska Native (AI/AN) community, which faces both racial and geographic disparities, is a group that should benefit from Medicaid expansion. This paper examines differences in medical debt and cost avoidance for rural American Indian and Alaskan Native households in Medicaid expansion and nonexpansion states. This study uses data from the National Financial Capability Study in binomial logistic regression models to examine whether AI/AN households in rural areas are more likely to have medical and engage in cost avoidance than their urban counterparts. The results show no differences between Medicaid expansion status but do find a higher likelihood of medical debt for those living in rural areas. The results also show a higher likelihood of medical debt and cost avoidance for those living farther from Indian Health Services (IHS)/Tribal health care facilities. The results indicate that rural AI/AN individuals continue to face financial barriers to health care despite the expansion of Medicaid under the ACA. This suggests that rural AI/AN individuals are seeking care outside of the IHS/Tribal system due to limited access to IHS providers. Addressing these barriers may require policies and programs focusing on rural AI/AN communities.

The uneven impact of Medicaid expansion on rural and urban Black, Latino/a, and White mortality.

To determine the differential impact of Medicaid expansion on all-cause mortality between Black, Latino/a, and White populations in rural and urban areas, and assess how expansion impacted mortality disparities between these groups. We employ a county-level time-varying heterogenous treatment effects difference-in-difference analysis of Medicaid expansion on all-cause age-adjusted mortality for those 64 years of age or younger from 2009 to 2019. For all counties within the 50 US States and the District of Columbia, we use restricted-access vital statistics data to estimate Average Treatment Effect on the Treated (ATET) for all combinations of racial and ethnic group (Black, Latino/a, White), rurality (rural, urban), and sex. We then assess aggregate ATET, as well as how the ATET changed as time from expansion increased. Medicaid expansion led to a reduction in all-cause age-adjusted mortality for urban Black populations, but not rural Black populations. Urban White populations experienced mixed effects dependent on years after expansion. Latino/a populations saw no appreciable impact. While no effect was observed for rural Black and Latino/a populations, rural White all-cause age-adjusted mortality unexpectedly increased due to Medicaid expansion. These effects reduced rural- and urban-specific Black-White mortality disparities but did not shrink the rural-urban mortality gap. The mortality-reducing impact of Medicaid expansion has been uneven across racial and ethnic groups and rural-urban status; suggesting that many populations-particularly rural individuals-are not seeing the same benefits as others. It is imperative that states work to ensure Medicaid expansion is being appropriately implemented in rural areas.

Moving Opportunistically: Interstate Migration after Medicaid Expansion

Moving Opportunistically: Interstate Migration after Medicaid Expansion

Citizenship-Based Disparities in Pediatric Liver Transplant Survival Following Medicaid Expansion

Citizenship-Based Disparities in Pediatric Liver Transplant Survival Following Medicaid Expansion

The Impact of Medicaid Expansion on Stage at Diagnosis of Melanoma Patients: A Retrospective Study.

This study addresses the lack of research on Medicaid expansion's impact on melanoma staging, treatment utilization, and outcomes by evaluating its effects under the Affordable Care Act (ACA), particularly focusing on staging at diagnosis, treatment use, and 3-year mortality outcomes. The objective is to determine whether Medicaid expansion led to earlier melanoma diagnosis and improved survival rates among non-elderly adults (ages 40-64) by analyzing data from the National Cancer Database (NCDB). A total of 12,667 patients, aged 40-64, diagnosed with melanoma from 2010 to 2020 were identified using the NCDB. Difference-in-difference (DID) analysis was performed to analyze tumor staging at presentation between Medicaid expansion states and non-Medicaid expansion states both prior to the expansion and after the expansion. Of the total patients, 2307 were from the pre-expansion time period residing in Medicaid expansion states (MES) and 1804 in non-Medicaid expansion states. In the post-expansion time period there were 5571 residing in the MES and 2985 in the non-MES. DID analysis revealed a decrease in stage IV melanoma at diagnosis (DID -0.222, p < 0.001) between MES and non-MES before and after Medicaid expansion. After expansion, in stage IV, the occurrence of primary surgery was 0.42 in non-MES and 0.44 (difference 0.02); DID analysis was not statistically significant. The use of immunotherapy in MES was significantly higher than in non-MES after expansion (p < 0.001), although DID analysis did not reveal a statistically significant difference. DID analysis showed a statistically significant decrease in 3-year mortality (DID -0.05, p = 0.001) between MES and non-MES before and after Medicaid expansion. This study revealed the positive impact of the ACA's Medicaid expansion on melanoma stage at presentation, highlighting the importance of public health policies in reducing disparities in mortality rates and early-stage diagnoses. Future research should explore additional barriers to care and evaluate the long-term outcomes of Medicaid expansion to optimize cancer care for vulnerable populations.

Is the Affordable Care Act Medicaid expansion in the USA associated with reductions in intimate partner violence victimisation?

Intimate partner violence (IPV) affects an estimated 47% of women living in the USA in their lifetime and is associated with increased risk of physical and mental health concerns. Current prevention efforts focus on individual and family-level interventions rather than macrosystem-level policies. Thus, we sought to test the effects of Medicaid expansion on the rates of IPV and violence more broadly. Present analyses use retrospective longitudinal data from the National Crime Victimization Survey (NCVS). State level rates of total violence and IPV were measured per 1000 population from the NCVS for years 2008-2018 as 3-year averages for each state. A two-way fixed-effects difference-in-differences model was fit to evaluate differences in the change in violence outcomes pre-2014/post-2014 in Medicaid expansion states versus non-expansion states. Comparison states had a significantly higher proportion of residents who were black, living below the federal poverty level and with lower educational attainment. Before Medicaid expansion, comparison states had a significantly lower mean rate of total violence and IPV per 1000 population. In two-way fixed effects difference-in-differences models, there was no statistically significant association between Medicaid expansion and IPV or total violence. Despite null findings, our study adds to the evidence base evaluating the impacts of macro-level policies on different forms of violence. The pathways by which Medicaid expansion could contribute to violence reduction are multifaceted with numerous mediators and those pathways may not be sufficiently strong to generate impacts. Additional work is warranted to further probe Medicaid expansion's impact on violence prevention.

The Impact of Medicaid Expansion on Congenital Heart Surgery Outcomes: Data From the Society of Thoracic Surgeons Database

BACKGROUND: The Affordable Care Act expanded Medicaid eligibility and increased public insurance coverage for children across the United States. As only a subset of states adopted expansion of coverage, disparities in insurance coverage between expansion and nonexpansion states emerged. We examined the association between Medicaid expansion and cardiac surgery outcomes to understand the impact of Medicaid expansion in a medically complex pediatric population. We hypothesized that expansion of Medicaid eligibility would be associated with greater improvement in surgical outcomes. METHODS: The Society of Thoracic Surgeons Congenital Heart Surgery Database was used to evaluate perioperative outcomes for children 0 to 18 years undergoing cardiac surgery between January 2010 and December 2019. We used a difference-in-differences (DiD) design to estimate the impact of Medicaid expansion on surgical outcomes by comparing changes in outcomes between individuals in expansion states and those in nonexpansion states, both before and after the expansion. Outcomes included operative mortality, major complications and postoperative length of stay (PLOS). RESULTS: The interaction between Medicaid expansion and time period post- vs preexpansion was not significant for any of the outcome variables. The odds ratio (OR) for mortality related to the Medicaid expansion was 1.12 (confidence interval [CI], 0.95–1.32, P = .161). For major complications, the OR was 0.99 (CI, 0.90–1.09, P = .770). For PLOS, the incidence rate ratio was 1.02 (CI, 0.99–1.05, P = .141). CONCLUSIONS: There was an overall decline in congenital heart surgery mortality over time; however, states that expanded Medicaid eligibility did not experience a greater improvement in mortality relative to states that did not expand eligibility. Similarly, there was no significant difference in major complications or PLOS related to Medicaid expansion. Further studies are needed to examine long-term outcomes and the larger spectrum of accessibility to congenital cardiac care which may benefit from insurance coverage.

Factors Associated With First-Trimester Prenatal Care Initiation In The United States: A Scoping Review.

First-trimester prenatal care is an important component of quality care during pregnancy and is associated with improved perinatal outcomes. Despite its importance, many pregnant people delay prenatal care initiation or receive no prenatal care. This scoping review assessed multilevel factors associated with first-trimester prenatal care initiation in the United States among studies that included a measure of prenatal care timing, using the socioecological model as an organizing framework. A scoping review was conducted according to the Joanna Briggs Institute methodology for scoping reviews and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines for reporting. PubMed, Cochrane, Embase, CINAHL, and Social Sciences Abstracts were searched for peer-reviewed papers that focused on facilitators and barriers associated with first-trimester prenatal care initiation, were written in English, included a measure of prenatal care timing, and used data gathered after 2014. Of the 1469 articles identified in the search, 19 met inclusion criteria and were included in the final review. Articles described intrapersonal, interpersonal, and environmental-level barriers and facilitators of first-trimester prenatal care initiation including Medicaid expansion, immigration status, and the COVID-19 pandemic. Significant heterogeneity in the measurement of prenatal care timing existed across studies. Our findings suggest that, although environmental domain factors have been impactful toward increasing population-level rates of first-trimester prenatal care initiation, benefits have not been equitable across sociodemographic factors. Increasing the proportion of pregnant people who initiate first-trimester prenatal care will require comprehensive efforts that address sociodemographic and contextual factors, including persistent structural and systemic barriers that cause and widen health disparities.

The relationship between food and housing insecurity and healthcare use among Virginia Medicaid expansion members: Considering the neighborhood context.

To understand relationships between healthcare use and food and housing insecurity in Medicaid expansion members, as well as whether these relationships differ by rurality or residential segregation. Database of Virginia Medicaid expansion members from the Department of Medical Assistance Services. Sample included individuals who enrolled January-June 2019, were aged 19-64 years, remained continuously enrolled for 12 months, and completed a Medicaid Member Health Screening (MMHS) conducted within the first 3 months of enrollment (n = 14,735). Retrospective cohort study. Outcomes included any primary care visits (PC) and any emergency department (ED) visits in the first 12 months of enrollment. The MMHS sample was weighted to represent all Medicaid expansion members (n = 234,296). Separate multivariable linear probability models regressed having any PC or ED visits on food and housing insecurity controlling for individual and neighborhood characteristics. Models were then stratified by rurality and racial residential segregation. None. Food insecurity was negatively associated with having any PC visit (-2.9 percentage points (PP); p-value <0.01) and positively associated with having any ED visit (7.0 PP; p-value <0.001). No significant relationships between PC or ED visits and housing insecurity were found. Suburban and urban individuals with food insecurity were significantly less likely to have any PC visit (p < 0.05 each). Medicaid expansion members living in disproportionately low-income or mixed-income neighborhoods experiencing food insecurity were also less likely to have any PC visits (p < 0.05), and the same was not true for those living in disproportionately high-income neighborhoods. Food insecurity among Medicaid expansion members is associated with less primary care and more emergency department use, but these relationships differ by the neighborhoods in which members live. Medicaid agency efforts that coordinate medical and social service benefits and also consider local context may further increase access to necessary and appropriate care.

Impact of medicaid expansion on screenable versus non-screenable gastrointestinal cancers

BackgroundMedicaid expansion afforded increased healthcare access to low-income Americans contributing to a positive impact on cancer outcomes. However, it is unclear if these benefits were mainly due to enhanced access to cancer screening and earlier diagnosis versus access to cancer treatment MethodsThe National Cancer Database (NCDB) was queried between 2010 and 2021 for Medicaid and uninsured patients with GI malignancies. Patients were stratified by screenable (SGI) and non-screenable (NGI) cancers and expansion state (ES) categories: early (EES) and late (LES) adopters, and non-expansion state (NES) cohorts. Statistical analyses, including difference-in-difference (DiD) and adjusted models, assessed the impact of Medicaid expansion on stage at diagnosis. ResultsThere were 230,159 pre-expansion and 539,028 post-expansion patients. There was an increase in Medicaid coverage (14.8 % vs. 11.1 %) and a concomitant decline in the uninsured population (5.3 % vs. 8.2 %) in the post-expansion era. For SGI cancers, Medicaid expansion was associated with significantly lower mean stage at diagnosis (DiD Coef. −0.12; p < 0.01). For NGI cancers, Medicaid expansion was associated with a lower mean stage at diagnosis but with much smaller coefficient (DiD Coef. −0.015; p < 0.01). Comparing EES and LES to NES, EES had more impact on lower mean stage at diagnosis (vs NES DiD Coef. −0.16; p < 0.01) compared to LES (vs NES DiD Coef. −0.02; p = 0.04) for SGI cancers. For NGI cancers, there was a modest reduction in mean stage at diagnosis only for EES (vs NES DiD Coef. −0.04; p < 0.01). ConclusionMedicaid expansion, particularly for SGI cancers and early adopters, had a profound impact in lowering the mean stage at diagnosis. This emphasizes that long-term advantages of providing access to preventive care and screening, and thus earlier treatment, may be one of the main mechanisms of Medicaid expansion on improving cancer outcomes for GI malignancies. Policy summaryTo establish the benefits of Medicaid expansion under the Affordable Care Act 2010 for gastrointestinal cancer patients particularly in screening.

Healthcare Policy and Equity in Tracheostomy Care: Navigating Access, Advocacy, and Reform

The evolving U.S. healthcare landscape poses significant challenges for individuals requiring tracheostomy care, their families, and healthcare teams. These patients, their care partners, and health professionals face significant medical and social challenges, necessitating coordinated, long-term support to maintain health, prevent complications, and enhance quality of life. While policies like the Affordable Care Act (ACA) and Medicaid expansion have reduced uninsured rates and improved access to critical services, sustaining these gains relies on the renewal of subsidies that broaden coverage. Systemic barriers—including coverage gaps, inequities, and administrative inefficiencies—persist. This commentary explores how healthcare reforms, including Medicaid expansion, enhanced ACA subsidies, and Medicare policy adjustments, can address these barriers. It also highlights the disproportionate burden on low-income and minority populations, as well as the strain on healthcare teams managing complex care needs. Advocacy efforts should focus on expanding coverage, reducing costs, and addressing social determinants of health to promote equitable, high-quality care for all patients.

Comment on ‘Sex &amp; marital differences in delayed pharyngeal cancer treatment before and after medicaid expansion’

Comment on ‘Sex &amp; marital differences in delayed pharyngeal cancer treatment before and after medicaid expansion’

Pregnancy-Related Mortality Disparities During the COVID-19 Pandemic.

Objectives. To compare pregnancy-related mortality ratios (PRMRs) associated with COVID-19 by race/ethnicity, by region of residence, and in states with and without Medicaid expansion. Methods. We used 2020-2021 data from the US Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research in our analysis. We stratified PRMRs by race/ethnicity, census regions, and Medicaid expansion and nonexpansion states. Results. The 2020-2021 PRMR was 40.3 per 100 000 live births. American Indian/ Alaska Native pregnant people had the greatest PRMR, followed by non-Hispanic Blacks and non-Hispanic Native Hawaiians/other Pacific Islanders. PRMRs associated with COVID-19 in the southern region were at least 2 times higher than in other regions and were highest for all pregnant people in the various racial/ethnic groups. PRMRs associated with COVID-19 were lower in Medicaid expansion states than in nonexpansion states. Conclusions. The US COVID-19 epidemic exacerbated racial and ethnic disparities in pregnancy-related mortality. Public Health Implications. The alarming increase in disparities among racial and ethnic pregnant people during the COVID-19 pandemic underscores the need to address social determinants of health at the structural level. (Am J Public Health. 2024;114(S9): S723-S730. https://doi.org/10.2105/AJPH.2024.307814).

Early effects of 2014 U.S. Medicaid expansions on mortality: Design-based inference for impacts on small subgroups despite small-cell suppression

Early effects of 2014 U.S. Medicaid expansions on mortality: Design-based inference for impacts on small subgroups despite small-cell suppression

Provider capacity during Medicaid expansion and a public health emergency.

To assess the capacity of Medicaid providers to take on new patients during a time of unprecedented growth in program enrollment due to Medicaid expansion and the COVID-19 public health emergency. We conducted a survey of Medicaid providers in Missouri in 2023 about their patient load and capacity to accept new patients. We recruited 141 Missouri Medicaid providers through probability sampling and 109 additional providers through convenience sampling for a total sample size of 250, representing 0.8% of all Medicaid providers in Missouri. Our survey was informed by semistructured interviews with 15providers conducted earlier in the year. We analyzed results using sample percentages with 95% CIs. As expected, a large majority of respondents reported that their patient load had increased since 2021. Nonetheless, 53% (47%-59%) reported that they personally had the capacity to take on additional patients, and 70% (65%-75%) reported that their larger practice had the capacity to do so. We found no evidence that these responses differed between large metropolitan areas and other areas of the state. Majorities also reported that their practices either had recently hired additional personnel (both staff and providers) or planned to do so, and substantial percentages reported other capacity-expanding changes. Our results suggest that the health care system in Missouri can accommodate even historic growth in Medicaid enrollment and patient loads without compromising access to care as perceived by providers. Further research is needed from the patient side and focused on rural areas.