Impact of Medicaid expansion on utilization of urgent care center, emergency department, and physician office visits among commercially- insured enrollees

Medicaid expansion has resulted in increased utilization of emergency departments by new adult Medicaid enrollees. The objective of this study was to assess if Medicaid expansion led to changes in access to care among commercially-insured persons by assessing changes in urgent care center (UCC), nonemergent emergency department (ED), and physician office visit rates among commercially-insured enrollees. Methods: Commercially-insured enrollees, aged 18–64 years, with at least 17 months of coverage during either the preperiod or post-period were included in the study. The outcome was defined as the count of unique visits occurring during the outcome assessment period (last 12 months for both periods) for each care setting (UCC, non-emergent ED, physician office). A state-level matched difference in difference analysis was used to assess the impact of expansion on the outcomes of interest. Results: The final sample consisted of 1.83 million enrollees. Medicaid expansion was associated with reduced UCC (absolute difference = -0.13, 95% CI = -0.24 to -0.01) and non-emergent ED (absolute difference = -1.59, 95% CI =- 1.82 to -1.36) and increased physician office (absolute difference = 32.63, 95% CI = 32.63 to 35.90) visit rates for commercially insured in the expanded state