Characterizing the Impact of Medicaid Expansion on Pediatric Liver Transplantation

J. D. Motter, A. Kernodle, D. L. Segev, A. B. Massie

Johns Hopkins University, Baltimore, MD

Meeting: 2020 American Transplant Congress

Abstract number: 435

Keywords: Liver transplantation, Medicare, Public policy, Waiting lists

Session Information

Session Name: All Organs: Public Policy & Allocation

Session Type: Oral Abstract Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:45pm

Presentation Time: 3:15pm-3:27pm

Location: Virtual

*Purpose: Under the Patient Protection and Affordable Care Act (ACA), states have the option to expand Medicaid eligibility (ME) which has allowed for increased access to healthcare coverage in the United States. We sought to characterize the impact of ME on access to the liver transplant (LT) waitlist for pediatric patients with end-stage liver disease (ESLD).

*Methods: We used national registry data from SRTR to study 4,279 incident US-resident pediatric LT waitlist registrants who resided in ME and non-ME states from 1/1/2012-31/12/2017. We characterized changes in center-level incident waitlist registration of Medicaid and non-Medicaid insured candidates in ME versus non-ME states, using generalized estimating equations.

*Results: Of the 4,279 pediatric LT registrants, 47.7% resided in a state that adopted ME in 1/1/2014, 10.7% resided in a state that adopted ME from 4/1/2014-31/7/2016, and 41.7% resided in a state that did not adopt ME. The proportion of Medicaid-insured registrants increased from 33.8% in 2012-2013 to 42.4% in 2015-2017 in ME states (p=0.002); however, this proportion did not change in non-ME states (2012-2013: 55.0%; 2015-2017: 56.5%, p=0.7) (Figure). Among registrants who underwent a living donor LT within 18 months of registration, the proportion insured with Medicaid increased over time in ME states, albeit non-significantly (2012-2013: 13.1%; 2014: 30.0%; 2015-2017: 27.4%, p=0.07); there was no difference in non-ME states (2012-2013: 41.7%; 2014: 36.7%; 2015-2017: 20.0%, p=0.4). Although the rate of pediatric, Medicare-insured registrants was comparable between ME and non-ME states in the first year post-ME (IRR: _0.941.16_1.42, p=0.2), transplant centers in ME states experienced a 34% increase thereafter (IRR: _1.091.34_1.65, p=0.005).

*Conclusions: Following the ACA, the proportion of pediatric Medicaid-insured registrants increased in ME states. Consequently, ME may have allowed for increased access to pediatric waitlisting and transplant for ESLD candidates in ME states.

To cite this abstract in AMA style:

Motter JD, Kernodle A, Segev DL, Massie AB. Characterizing the Impact of Medicaid Expansion on Pediatric Liver Transplantation [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/characterizing-the-impact-of-medicaid-expansion-on-pediatric-liver-transplantation/. Accessed July 5, 2025.

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