Medicaid expansion increased Medicaid enrollment among liver transplant recipients

Because liver transplant recipients in the United States have low rates of paid employment, many are eligible for Medicaid public health insurance after their surgery. In a new study, Dmitry Tumin, PhD, of Nationwide Children's Hospital and The Ohio State University College of Medicine in Columbus, and his colleagues looked to see whether recent expansions of Medicaid eligibility increased Medicaid enrollment and insurance coverage in these patients.

By examining information from the United Network for Organ Sharing registry, the researchers identified 12,837 patients ages 18 to 59 years who received first-time liver transplants between 2009 and 2013. Among the major findings:

• A total of 6554 patients (51 percent) lived in states that expanded Medicaid eligibility in 2014.
• Medicaid participation after liver transplantation was more common in Medicaid-expansion states (25 percent) compared with non-expansion states (19 percent).
• In 7279 patients with private insurance at the time of transplantation, the likelihood of enrolling in Medicaid after expansion increased by 50 percent in states participating in Medicaid expansion but there was no increase in states opting out of expansion.
• There was no effect of Medicaid expansion on use of posttransplant uninsured care, which was uncommon regardless of whether patients had private or government insurance at the time of transplantation.

The results indicate that Medicaid expansion increased post-transplant Medicaid enrollment among patients who had private insurance at the time of transplantation; however, it did not appear to improve overall access to health insurance among liver transplant recipients.

"Our study presents the first evidence of how Medicaid expansion affected health insurance coverage of liver transplant recipients," said Dr. Tumin. "Our findings indicate the need to understand how Medicaid expansion affected access to care, out-of-pocket expenditures, and clinical outcomes among liver transplant recipients, given the changes in their insurance status occurring due to this policy."