IMPACT OF EXPANDED MEDICAID COVERAGE ON HOSPITAL LENGTH STAY FOLLOWING INJURY

IMPACT OF EXPANDED MEDICAID COVERAGE ON HOSPITAL LENGTH STAY FOLLOWING INJURY INTRODUCTION Despite implementation of the Affordable Care Act (ACA) in 2010, 32 states – including The District of Columbia (DC) and Maryland (MD) – expanded their Medicaid insurance coverage, while nineteen states, including Virginia (VA), did not expand their coverage. The region served by the trauma center at George Washington University Hospital (GWUH) represents three unique payer systems with liberal, moderate, and no Medicaid expansion (DC, MD, and VA, respectively). Trauma centers are required to treat all patients regardless of insurance status, yet patients may have different hospital length of stay (LOS) depending on their access to care post-discharge. The purpose of this study is to identify if expanded Medicaid eligibility in DC and MD correlates with a shorter LOS for trauma patients. METHODS A retrospective study of trauma registry patients admitted to the GWUH, a Level 1 adult urban trauma center, during a 38-month period (January 1, 2013 to March 6, 2016) was performed. Patients encompassed those on non-commercial insurance, including Medicare and Medicaid, as well as those who are uninsured. Patients with commercial insurance or whose payer information was not identified were excluded. Additionally, patients who were pronounced dead on arrival or who died during their hospitalization were excluded. Primary outcome measures were comparison of type of insurance and LOS by state of residence among DC, MD and VA. RESULTS During the study period, 4883 patients were admitted to the trauma service with 2728 patients enrolled per our inclusion criteria. Medicaid patients from DC had a significantly shorter average LOS (2.64 days) than patients from MD (3.53 days, p = 0.003) or VA (4.56 days, p = 0.02). This difference persisted after controlling for Abbreviated Injury Score (AIS) for both head and pelvis, Injury Severity Score (ISS), gender, age, and penetrating mechanism of injury in our multivariate linear regression model. CONCLUSION The District of Columbia and MD, states that participated in Medicaid expansion, are associated with shorter hospital LOS for trauma patients than the non-expansion state of VA. However, as the result of the differing Medicaid coverage eligibility requirements in DC and MD, discrepancy also exists in LOS between these states. It is expected that Medicaid expansion is associated with shorter hospital LOS for trauma patients due to increased access to rehabilitation facilities and home health services. Future work investigating the discharge destination of Medicaid patients under the ACA is needed