• Lindsay M Sabik, Peter J Cunningham, and Ali Bonakdar Tehrani.
• *Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA †Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA ‡Truven Health Analytics, Bethesda, MD.
• Med Care. 2017 Jun 1; 55 (6): 576-582.

BackgroundMedicaid expansions aim to improve access to primary care, which could reduce nonemergent (NE) use of the emergency department (ED). In contrast, Medicaid enrollees use the ED more than other groups, including the uninsured. Thus, the expected impact of Medicaid expansion on ED use is unclear.ObjectivesTo estimate changes in total and NE ED visits as a result of California's early Medicaid expansion under the Affordable Care Act. In addition to overall changes in the number of visits, changes by payer and safety net hospital status are examined.MethodsWe used a quasi-experimental approach to examine changes in ED utilization, comparing California expansion counties to comparison counties from California and 2 other states in the same region that did not implement Medicaid expansion during the study period.ResultsRegression estimates show no significant change in total number of ED visits following expansion. Medicaid visits increased by 145 visits per hospital-quarter in the first year following expansion and 242 visits subsequent to the first year, whereas visits among uninsured patients decreased by 129 visits per hospital-quarter in the first year and 175 visits in subsequent years, driven by changes at safety net hospitals. We also observe an increase in NE visits per hospital-quarter paid for by Medicaid, and a significant decrease in uninsured NE visits.ConclusionsMedicaid expansions in California were associated with increases in ED visits paid for by Medicaid and declines in uninsured visits. Expansion was also associated with changes in NE visits among Medicaid enrollees and the uninsured.

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