Understanding Churn in Medicaid Coverage Following the ACA

Brown University, a private Ivy League University located in Providence, Rhode Island, offers an exceptional research program which was a primary attraction for Dr. Sarah Gordon who earned her Doctorate in Health Services Research in 2019. While working on her dissertation, Dr. Gordon was eager to use data that could measure the impact of the 2010 Affordable Care Act. “For this project, we wanted to see [whether] not only expansion increased the absolute number of people who had coverage in Colorado, but [whether] they were given more continuous, uninterrupted and long-lasting coverage,” says Dr. Gordon. The challenge now was to identify data sources for the research that she hoped would inform future policies that reduce costs and improve quality of care.

While searching for sources of information for her project, Sarah discovered the Center for Improving Value in Health Care (CIVHC) and the Colorado All Payer Claims Database (CO APCD). “In the US, there are different types of insurance for different people and we have no idea how people move through the system. All Payer Claims Databases are one of the only ways to get data to answer these system-wide questions,” says Dr. Gordon.

Working with the CIVHC team, she was able to identify the data elements for her project and determined, since she did not need a large amount of protected health information (PHI), a Limited Dataset was the best fit for her request. Dr. Gordon was able to use CO APCD data to conduct a two-state analysis between Colorado, a state that expanded Medicaid, to Utah, a non-expansion state. The results, published in the Journal of Internal General Medicine, show the Affordable Care Act was an effective strategy in reducing “churn”, a term referring to the transition of members between different types of health insurance and/or becoming uninsured – in this case, for Medicaid members.

Since completing her doctorate at Brown University, Sarah moved to Boston University as an Assistant Professor where she continues to use the CO APCD for research on health insurance/policy, population health, and access to care. She has most recently linked the CO APCD with other state-level data sources, including income data and birth records, to study continuity of insurance enrollment among pregnant women in the Medicaid program.

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