Lean Medicaid policies cause delays

States and counties with a high prevalence of delayed care had a weaker Medicaid infrastructure

States with restrictive Medicaid eligibility need to alter those policies to reduce delayed medical care, according to a recent New England Journal of Medicine letter to the editor.

Cheryl R. Clark, MD, director of Health Equity Research and Intervention in the Center for Community Health and Health Equity at Brigham and Women’s Hospital and Mark J. Ommerborn, MPH, with Brigham and Women’s Hospital, coauthored new Medicaid research that was published in the NEJM letter, March 28, 2013.

Dr. Clark and colleagues examined county-level geographic variation in the prevalence of delayed care-specifically seeing a physician-because of cost among 280,333 adults in the 2010 Behavioral Risk Factor Surveillance System (BRFSS) survey. The researchers also reviewed the relationship between Medicaid eligibility thresholds for working adults with children and the odds that BRFSS survey participants would delay seeking care.

“Our results suggest stark geographic differences in the prevalence of care delayed because of cost. States and counties with a high prevalence of delayed care had a weaker healthcare infrastructure than states with a lower prevalence of delayed care,” Dr. Clark wrote.

Particularly vulnerable areas were in the South, including Texas and Florida. Populations in counties with the highest prevalence of delayed care were more likely to be Hispanic and have low incomes and a high prevalence of chronic disease. States with more restrictive eligibility will likely need additional investments in Medicaid to catch up to expected coverage levels demanded by the Patient Protection and Affordable Care Act.