New cases of diabetes in Medicaid patients soar in expansion states

Modern Healthcare, March 23, 2015

The number of Medicaid patients diagnosed with diabetes soared in states that expanded Medicaid eligibility to low-income adults last year compared to what happened in states that did not expand their Medicaid programs.

The findings, in the May issue of the journal Diabetes Care, add to the growing evidence that expanding insurance coverage, particularly for vulnerable populations, can help improve health outcomes.

“Not only were there more patients, but they were identified at an earlier stage,” said Dr. Harvey Kaufman, Quest Diagnostics' senior medical director and lead study author. “These individuals are likely to slow the progression of their diabetes. By engaging these people earlier, we lower the risk and the high cost of this disease.”

New diagnoses of diabetes among Medicaid patients increased 23% in the 26 states that expanded their insurance programs compared with just 0.4% in the 24 states that did not. A similar increase was not seen among patients with other types of insurance coverage.

For the study, laboratory testing company Quest analyzed the number of samples it received with a diagnostic code indicating diabetes or a hemoglobin AlC level above 6.4%. Researchers compared samples taken during the first six months of 2014 compared with the same period in 2013.

Medicaid patients who received new diabetes diagnoses in expansion states also had an average A1C level that was lower than patients in non-expansion states.

Quest chose to look at diabetes because of its high prevalence as well as its high level of treatability, especially when caught early, Kaufman said. However, looking at other chronic conditions would have likely yielded the same results, he theorized.

An accompanying editorial urges policymakers, especially in non-expansion states, to consider how barriers to care affect chronic disease management.

“Although encouraging, none of these findings is particularly startling,” write Drs. William Herman and William Cefalu, diabetes experts at the University of Michigan Health System and LSU Health, respectively. “It is not surprising that reducing financial barriers to care might encourage utilization, facilitate control and improve outcomes.”

A study as far back as 2009 found that Medicaid patients were nearly twice as likely to be diagnosed with diabetes as the uninsured—which likely reflects that many uninsured individuals without coverage were slipping through the cracks, the editorial noted.

As a group, non-expansion states had a higher overall increase in new diabetes diagnoses, 2.6% compared with 0.8% in expansion states. Yet the study points out that nine of the 11 states with some of the country's highest rates of stroke, obesity and cardiovascular disease did not expand Medicaid. These include Southern states such as Alabama, Louisiana and Mississippi, and others that score low on health report cards.

The study did not otherwise break out state-level data.

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