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Kidney Week

Abstract: PO2062

Association of Medicaid Expansion with Medicaid Uptake and Uninsurance Among US Kidney Transplant Recipients

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Kotzen, Elizabeth, UNC Kidney Center, Chapel Hill, North Carolina, United States
  • Detwiler, Randal K., UNC Kidney Center, Chapel Hill, North Carolina, United States
  • Flythe, Jennifer E., UNC Kidney Center, Chapel Hill, North Carolina, United States
Background

The differential uptake of Medicaid expansion among U.S. states following the Affordable Care Act created a natural experiment to investigate the association between Medicaid expansion and health insurance usage patterns among kidney transplant (KT) recipients. Adolescents and young adults (AYA) are at particular risk for insurance access disruption.

Methods

Using data from the Scientific Registry of Transplant Recipients, we constructed a multivariable difference-in-differences model to evaluate the association between living in a state with Medicaid expansion (vs. a state without) and two outcomes: primary insurance of Medicaid at the time of KT, and being uninsured 5 years following KT. We included U.S. recipients of kidney-alone transplantation between 1/1/2005 and 3/12/2020. We analyzed AYA (ages 15-26 years) and other nonelderly adults (ages 27-64 years) separately.

Results

The AYA group included 17,158 KT recipients, while the group of adults 27-64 years included 198,914 KT recipients. The effect of living in a Medicaid expansion state (vs. a nonexpansion state) on use of Medicaid as the primary insurance type at the time of KT was +1.9% (95% CI -0.4% to +4.3%) for the AYA group and +1.7% (95% CI +1.3% to +2.1%) for the non-elderly adult group. The effect of living in a Medicaid expansion state (vs. a nonexpansion state) on being uninsured 5 years after KT was -3.6% (95% CI -6.5% to -0.7%) for the AYA group and -0.9% (95% CI -1.3% to -0.4%) for the non-elderly adult group.

Conclusion

Living in a Medicaid expansion state was associated with greater use of Medicaid at the time of KT for adults ages 27-64, but not in the AYA group. In both age groups, living in a Medicaid expansion state was associated with a modest reduction in being uninsured 5 years following KT. Increased access to Medicaid may provide a protective effect against becoming uninsured after KT.

Results of difference-in-differences analysis examining the association of exposure to Medicaid expansion with insurance outcomes among U.S. KT recipients.*
OutcomeAge group (years)Adjusted change after expansion in EXPANSION states, percentage points (95% CI)Adjusted change after expansion in NON-EXPANSION states, percentage points (95% CI)Adjusted difference-in-differences estimate, percentage points (95% CI)
Medicaid as primary insurance at the time of KT15-26+4.1 (+2.6, +5.6)+2.6 (+0.9, +4.2)+1.9 (-0.4, +4.3)
27-64+2.2 (+1.9, +2.5)+0.8 (+0.5, +1.0)+1.7 (+1.3, +2.1)
Uninsured 5 years following KT15-26-1.1 (-2.6, +0.3)+2.8 (+0.2, +5.3)-3.6 (-6.5, -0.7)
27-64-0.4 (-0.6, -0.1)+0.2 (-0.1, +0.6)-0.9 (-1.3, -0.4)

*Adjusted for gender, race/ethnicity, cause of kidney failure, year of KT, and state fixed effects.

Funding

  • NIDDK Support