The Effect of Medicaid Expansion on Access to Anti-incontinence Surgery.

Importance: Medicaid expansion broadened access to care; however, limited data about the effect on access to anti-incontinence surgical procedures exist.

Objective: Since the Affordable Care Act (ACA) Medicaid expansion in 2014, some regions have had more states adopt expansion (NE-Northeast, W-West) than other regions (S-South, MW-Midwest). We aimed to determine if the proportion of Medicaid funded anti-incontinence procedures increased after Medicaid expansion and whether increases were different by U.S. region.

Study Design: This was a retrospective cohort study.

Results: The 2012-2018 Healthcare Cost and Utilization Project National Inpatient Sample was reviewed for anti-incontinence surgical procedures. Medicaid supported surgical procedures were compared by region and year, and among marginalized populations. During the study period 66,510 surgical procedures were performed. Medicaid as a primary payer for anti-incontinence procedures increased from 10% to 12% (P = <0.001) between 2012 and 2018. The percentage of Medicaid supported procedures performed in the NE (13%) and W (17%) were greater than MW (9%) and S (8%). Procedures among Black, Hispanic or lowest income quartile patients were lowest in the S and did not increase after expansion during the study period (2012 vs 2018, all P = NS). When controlling for confounders, the MW (odds ratio [OR] 0.58; 95% CI 0.46-0.74) and S (OR 0.33; 95% CI 0.26-0.42) were less likely to have Medicaid covered surgical procedures compared to the NE and W (OR 1.04; 95% CI 0.84-1.29).

Conclusions: Nationally, the percentage of Medicaid-supported anti-incontinence procedures increased after expansion. Northeast and W access to procedures increased, and access by marginalized populations broadened, while the S and MW had the most limited proportion of anti-incontinence surgical procedures covered by Medicaid.