Medicaid Expansion Alone Not Associated With Improved Finances, Staffing, Or Quality At Critical Access Hospitals.

Critical access hospitals are important providers of care for rural and other underserved communities, but they face staffing and quality challenges while operating with low margins. Medicaid expansion has been found to improve hospital finances broadly and therefore may have permitted sustained investments in staffing and quality improvement at these vulnerable hospitals. In this difference-in-differences analysis, we found that critical access hospitals in Medicaid expansion states did not have statistically significant postexpansion increases in operating margins relative to hospitals in nonexpansion states.