Delay in medical care among Medicaid population due to restrictive state policies


Restrictive state Medicaid policies are delaying care because of cost and should be reconsidered, according to a recent NEJM letter to the editor.


States with restrictive Medicaid policies need to alter those policies because of delayed medical care, according to a recent New England Journal of Medicine letter to the editor.

Cheryl R. Clark, MD, director of Health Equity Research and Intervention in the Center for Community Health and Health Equity at Brigham and Women’s Hospital and Mark J. Ommerborn, MPH, with Brigham and Women’s Hospital, co-authored new Medicaid research that was published in the NEJM letter, published March 28, 2013.

Clark and colleagues examined county-level geographic variation in the prevalence of delayed care – specifically seeing a physician – because of cost among 289,333 adults in the 2010 Behavioral Risk Factor Surveillance System (BRFSS) survey. The researchers also reviewed the relationship between Medicaid eligibility thresholds for working adults with children and the odds that BRFSS survey participants would delay seeking care.

“Our results suggest stark geographic differences in the prevalence of care delayed because of cost. States and counties with a high prevalence of delayed care had a weaker health care infrastructure than states with a lower prevalence of delayed care,” Clark wrote. Particularly vulnerable areas were in the South, including Texas and Florida.

Populations in counties with the highest prevalence of delayed care were more likely to be Hispanic and have low incomes and a high prevalence of chronic disease. “And, these areas had a relatively late history of state Medicaid expansion,” Clark wrote.

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