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Medicaid Expansion Increases Access to Kidney Transplants

FRIDAY, Sept. 13, 2019 -- There was an increase in Medicaid-covered preemptive kidney transplants (KT) among patients with end-stage renal disease (ESRD) living in Medicaid expansion states versus nonexpansion states, according to a study published online Aug. 19 in the Journal of General Internal Medicine.

Meera N. Harhay, M.D., from the Drexel University College of Medicine in Philadelphia, and colleagues used data from the national Organ Procurement and Transplantation Network to identify nonelderly U.S. adults (aged 21 to 64 years) who received preemptive KT from 2010 through 2017. The proportions of deceased donor KT (DDKT) and living donor KT (LDKT) that were Medicaid-covered were compared before and after the implementation periods in Medicaid expansion states (31 states plus the District of Columbia) versus before and after January 1, 2014, in 19 nonexpansion states.

The researchers identified 15,775 preemptive KT recipients (median age, 51 years; 56 percent male; 71 percent white). Medicaid-covered preemptive KT recipients from Medicaid expansion states were more likely to be minorities and to be employed versus those from nonexpansion states. The total number of preemptive KTs with Medicaid coverage increased by 37 percent in nonexpansion states versus 66 percent in expansion states. There was a 0.8 percentage-point increase in the proportion of preemptive DDKTs with Medicaid coverage in nonexpansion states versus a 3.8 percentage-point increase in expansion states. A similar pattern was seen for LDKT with Medicaid coverage: 0.7 percentage-point increase in nonexpansion states versus a 2.2 percentage-point increase in expansion states.

"Given the ongoing coverage gap in states that did not expand Medicaid, the lack of affordable health insurance persists as a substantial barrier to preemptive KT for low-income individuals in the U.S. with ESRD," the authors write.

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Posted: September 2019