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Liver transplants' effect on patients' health insurance post-Medicaid expansion

Findings published in Liver Transplantation suggest the number of patients who switched from private insurance to Medicaid post-liver transplant was greater in Medicaid expansion states than non-expansion ones.

“The growing representation of Medicaid participation among [liver transplant] recipients underscores the need to examine insurance transitions after [solid organ transplantation (SOT)] and to identify how these transitions contribute to socioeconomic disparities in patient outcomes and overall rates of mortality, graft loss, and complications among transplant recipients,” Dmitry Tumin, PhD, of the department of pediatrics and Comprehensive Transplant Center, Wexner Medical Center, The Ohio State University and Center for Epidemiology of Organ Failure and Transplantation, Nationwide Children’s Hospital, Columbus, Ohio, and colleagues wrote. “We evaluated this approach using critical flicker frequency and MELD score. In over a quarter of the study population, further testing could be avoided with a high diagnostic accuracy.”

In the speculative study, the researchers reviewed a cohort of 12,387 patients — evenly split between those who lived in states that expanded Medicaid and those that did not — aged between 18 and 59 years who underwent LT. Medicaid participation was more prevalent in expansion states (25%; n = 1,624) than those in nonexpansion states (19%; n = 1,183).

Race, education, employment status pre-LT and age affected a patient’s insurance decision, the researchers wrote. Few insurance changes were observed among patients with hepatocellular carcinoma, hepatitis C virus and alcohol-induced liver disease; those with chronic liver disease were even less likely to switch. Follow-up data were limited due to fluctuations in follow-up appointments and medical staff entering insurance information post-LT.

Though more health evaluations are needed on LT recipients who recently became eligible for Medicaid, its expansion addressed an unmet need, Barry Schlansky, MD, MPH, of the division of gastroenterology and hepatology, Oregon Health and Science University and Carmel Shachar, JD, MPH, of the Center for Health Law and Policy Innovation, Harvard Law School wrote in a related editorial.

“Increasing access to LT in the uninsured population fulfills not only the principle of beneficence, by providing the only effective treatment for liver failure to underserved, vulnerable patients, but also the principle of justice,” they said.

Tumin and colleagues wrote some fallout from Medicaid expansion as a result of the Affordable Care Act (ACA) was expected, particularly in which patients were recommended for LT, billing, remunerations and prognosis. Health insurance and Medicaid choices post-LT both before and after ACA took effect are important too, they wrote.  

“Focusing on the population receiving LT just prior to Medicaid expansion, this study has demonstrated that post-LT Medicaid was influenced by this policy change,” Tumin and colleagues wrote. “Therefore, the effects of ACA on health insurance transitions among LT recipients may influence risk factors and clinical outcomes in all surviving LT recipients, not only those who underwent transplantation after the policy’s implementation.” – by Janel Miller

Disclosure: The researchers, Schlansky and Shachar report no relevant financial disclosures.