3033 — Use of VA and Medicaid Services for Dual Enrollees

Yoon J, VA Palo Alto; Vanneman M, VA Palo Alto; Dally S, VA Palo Alto; Trivedi A, Providence VAMC; Phibbs C, VA Palo Alto;

Objectives:
Many low-income veterans without employer-based coverage are now eligible for Medicaid coverage under the Affordable Care Act. There are limited data to guide VA providers and policymakers about the potential effects of Medicaid expansion on the demand for VA care. We evaluated longitudinal changes in VA utilization among nonelderly veterans who acquired Medicaid coverage prior to the ACA. We also examined predictors of Medicaid utilization.

Methods:
We identified a cohort of nonelderly VA users without Medicare coverage who acquired Medicaid from CY2006-2009 in 32 states. Using VA and Medicaid administrative data, we measured changes in VA inpatient and outpatient utilization from one year prior to and one year after Medicaid enrollment. We also measured Medicaid utilization during the year after Medicaid enrollment. Poisson regression models were used to estimate counts of outpatient visits and inpatient stays provided by Medicaid adjusting for patient factors and state.

Results:
There were 22,358 nonelderly veterans who acquired dual coverage by VA and Medicaid for at least one month between 2006 and 2009, with an average Medicaid enrollment of 9 months in the year after Medicaid enrollment. In the year prior to Medicaid enrollment, veterans received a mean of 21 (SD = 35) outpatient encounters and 0.3 (SD = 1) inpatient stays provided by VA. In the year following Medicaid enrollment, veterans received a mean of 23 (SD = 40) outpatient encounters and 0.3 (SD = 1) inpatient stays in VA and a mean of 8 (SD = 17) outpatient visits and 0.3 (SD = 1) inpatient stays financed by Medicaid. While 15% of patients used no VA services, 41% used no Medicaid services after enrolling in Medicaid. In adjusted models, veterans who were older, female, non-Hispanic White, sicker, qualified for Medicaid as pregnant women, and had a longer drive time to a VA provider used more Medicaid services than other veterans (all P < 0.001).

Implications:
After enrolling in Medicaid, veterans did not reduce their use of VA care. There was modest use of Medicaid services, although certain groups of veterans exhibited greater use of Medicaid services.

Impacts:
For previous users of VA care, impact of dual enrollment in Medicaid on VA demand may be limited.