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EMERGENCY MEDICAID PROGRAMS MAY BE AN EFFECTIVE MEANS OF PROVIDING SUSTAINED INSURANCE AMONG TRAUMA PATIENTS: A STATEWIDE LONGITUDINAL ANALYSIS. The journal of trauma and acute care surgery Knowlton, L. M., Tran, L. D., Arnow, K., Trickey, A. W., Morris, A. M., Spain, D. A., Wagner, T. H. 2022

Abstract

INTRODUCTION: Hospital Presumptive Eligibility (HPE) is a temporary Medicaid insurance at hospitalization that offsets costs of care, increases access to post-discharge resources, and provides patients with a path to sustain coverage through Medicaid. As HPE only lasts up to 60 days, we aimed to determine Medicaid insurance status six months after injury among HPE-approved trauma patients and identify factors associated with successful sustainment.METHODS: Using a customized longitudinal claims dataset for HPE-approved patients from the California Department of Health Care Services (DHCS), we analyzed adults with a primary trauma diagnosis (ICD-10) who were HPE approved in 2016 and 2017. Our primary outcome was Medicaid sustainment at six months. Univariate and multivariate analyses were performed.RESULTS: A total of 9,749 trauma patients with HPE were analyzed; 6,795 (69.7%) sustained Medicaid at six months. Compared to patients who did not sustain, those who sustained had higher injury severity score (ISS > 15: 73.5% vs. 68.7%, p < 0.001), more frequent surgical intervention (74.8% vs. 64.5%, p < 0.001) and were more likely to be discharged to post-acute services (23.9% vs. 10.4%, p < 0.001). Medicaid sustainment was high among patients who identified as White (86.7%), Hispanic (86.7%), Black (84.3%) and Asian (83.7%). Medicaid sustainment was low among the 2,505 patients (25.7%) who declined to report race, ethnicity, or preferred language (14.8% sustainment). In adjusted analyses, major injuries (ISS > 16) (vs. ISS < =15: aOR 1.51, p = 0.02) and surgery (aOR 1.85, p < 0.001) were associated with increased likelihood of Medicaid sustainment. Declining to disclose race, ethnicity, or language (aOR 0.05, p < 0.001) decreased the likelihood of Medicaid sustainment.CONCLUSION: HPE programs are a promising pathway for securing long-term insurance coverage for trauma patients, particularly among the severely injured who likely require ongoing access to healthcare services. Patient and provider interviews would help to elucidate barriers for patients who do not sustain.LEVEL OF EVIDENCE: Epidemiologic, Level III.

View details for DOI 10.1097/TA.0000000000003796

View details for PubMedID 36138539