• Brigit Hatch, Steffani R Bailey, Stuart Cowburn, Miguel Marino, Heather Angier, and Jennifer E DeVoe.
• Brigit Hatch, Steffani R. Bailey, Miguel Marino, Heather Angier, and Jennifer E. DeVoe are with Oregon Health and Science University, Portland. Stuart Cowburn and Jennifer E. DeVoe are with OCHIN, Portland.
• Am J Public Health. 2016 Apr 1; 106 (4): 645-50.

ObjectivesTo assess longitudinal patterns of community health center (CHC) utilization and the effect of insurance discontinuity after Oregon's 2008 Medicaid expansion (the Oregon Experiment).MethodsWe conducted a retrospective cohort study with electronic health records and Medicaid data. We divided individuals who gained Medicaid in the Oregon Experiment into those who maintained (n = 788) or lost (n = 944) insurance coverage. We compared these groups with continuously insured (n = 921) and continuously uninsured (n = 5416) reference groups for community health center utilization rates over a 36-month period.ResultsBoth newly insured groups increased utilization in the first 6 months. After 6 months, use among those who maintained coverage stabilized at a level consistent with the continuously insured, whereas it returned to baseline for those who lost coverage.ConclusionsIndividuals who maintained coverage through Oregon's Medicaid expansion increased long-term utilization of CHCs, whereas those with unstable coverage did not.Policy ImplicationsThis study predicts long-term increase in CHC utilization following Affordable Care Act Medicaid expansion and emphasizes the need for policies that support insurance retention.

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