Association between Medicaid Expansion under the Affordable Care Act and Preemptive Kidney Transplantation of Low-Income Medicaid Beneficiaries
1Medicine, Drexel University College of Medicine, Philadelphia, PA, 2Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia, PA
Meeting: 2019 American Transplant Congress
Abstract number: 352
Keywords: Kidney transplantation, Public policy
Session Information
Session Name: Concurrent Session: Non-Organ Specific: Public Policy & Allocation
Session Type: Concurrent Session
Date: Monday, June 3, 2019
Session Time: 4:30pm-6:00pm
Presentation Time: 4:42pm-4:54pm
Location: Room 311
*Purpose: The lack of affordable health insurance options is a known barrier to preemptive kidney transplantation (KT) among low-income individuals with non-dialysis dependent chronic kidney disease in the United States (US). We examined whether expansion of Medicaid under the Affordable Care Act (ACA) was associated with differences in the number of non-elderly US individuals who received preemptive KT with Medicaid coverage.
*Methods: Using the United Network of Organ Sharing database, we performed a retrospective observational study of non-elderly individuals (age <65 years) who received preemptive KT between January 1, 2010-December 31, 2017 in the US. Multi-organ recipients were excluded, as were those with insurance types other than private, Medicare, or Medicaid. After standardizing dates of Medicaid expansion, we fit a multivariable logistic regression model to compare pre/post trends in preemptive KT with Medicaid-coverage between states that expanded Medicaid under the ACA during the study period (n=31 states and the District of Columbia) and states that did not expand Medicaid (n=19).
*Results: Among 17,400 preemptive KTs included during the study period, 1,361 (7.8%) were covered by Medicaid. Pre-expansion, the proportion of preemptive KTs with Medicaid-coverage was one percentage-point higher among expansion states compared to non-expansion states (7.1% vs 6.1%, p=0.08). Post-expansion, the proportion of preemptive KTs with Medicaid-coverage was 2.4 percentage-points higher among expansion states than non-expansion states (9.7% vs 7.3%, p<0.001). Comparing the pre- to post-expansion periods by donor type, the proportion of living donor preemptive KTs covered by Medicaid increased by 1.3 percentage-points in non-expansion states (2.6% to 3.9%, p=0.04), and by 2.4 percentage-points in expansion states (4.3% to 6.7%, p<0.001). In an age, race, and sex-adjusted quarterly analysis of Medicaid coverage trends, sustained increases in Medicaid-coverage of preemptive KT were observed starting three quarters (i.e., 9 months) after the expansion date [Figure].
*Conclusions: Medicaid expansion under the ACA was associated with a modest but sustained increase in the proportion of preemptive KTs, including living donor preemptive KTs, that were covered by Medicaid.
To cite this abstract in AMA style:
Harhay MN, McKenna R. Association between Medicaid Expansion under the Affordable Care Act and Preemptive Kidney Transplantation of Low-Income Medicaid Beneficiaries [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/association-between-medicaid-expansion-under-the-affordable-care-act-and-preemptive-kidney-transplantation-of-low-income-medicaid-beneficiaries/. Accessed May 9, 2025.« Back to 2019 American Transplant Congress