By Tracy Sexton
July’s Health Affairs issue is dedicated to the 50th anniversary of Medicaid. Unsurprisingly, several articles within this issue feature the substantial role played by health centers, another program celebrating 50 years of service, in providing care to a significant portion of the Medicaid population. In Shin and colleagues’ article discussing the interdependence of the health center and Medicaid programs, the authors review the rich history of the Medicaid-health center relationship while stressing the importance of a continued and evolving partnership. [Note: Unfortunately, access to the full text of Shi et al.’s article requires paid subscription or purchase.]
Authors explain that Medicaid and health centers work together to accomplish a key goal – that is, improving access to quality primary care for otherwise un-served populations – by providing needed sources of primary care and the financing to support and expand it. The article notes that both Medicaid and federal health center grants have helped make health center growth possible by sustaining provided services. Health centers can help Medicaid achieve its growing focus on population health by, for example, serving complex patients with complicated health needs, particularly when other providers are still limiting their participation in Medicaid or not accepting Medicaid patients at all. In addition, health centers provide continuous care even when patients experience interruptions in Medicaid coverage. This is especially important for those with chronic conditions who require consistent and reliable care. Finally, given the substantial reach into underserved communities nationally, leveraging Medicaid-health center partnerships can reach uninsured and other patient populations by ensuring interventions reach all patients. Looking forward, authors state that a more “deliberate” and “purposeful” collaboration between Medicaid and health centers can accelerate advancements in quality and efficiency by sustainably financing accessible health care for underserved patients.
Just as health centers serve a substantial number of patients with Medicaid, they also serve a high proportion—about twice the national rate—of patients with both Medicaid and Medicare. These so-called “dual eligible” patients tend to be highly complex, in poverty, members of racial/ethnic groups, suffer from multiple chronic conditions, and have high rates of preventable hospitalizations and emergency department (ED) visits. Wright and colleagues explore the link between use of health centers and both hospitalizations and ED visits for ambulatory care sensitive conditions among those patients enrolled as dual eligibles. Specifically, they examine rates of these kinds of visits and hospitalizations among dual eligible patients living in Primary Care Service Areas containing a health center, comparing those who sought care at a health center with those who did not. This was done by collecting and analyzing fee-for-service Medicare Part A and Medicare Part B claims data from 2008-2010. Individuals were considered health center users if they had visited a health center one time or more within a year. The authors find that Black and Hispanic dual-eligible health center patients are less likely to be hospitalized for ambulatory-care sensitive conditions when compared to those not seeking care at a health center. However, the same trend is not seen for emergency department visits. Therefore, the authors conclude that strong evidence exists to suggest that health centers help reduce racial and ethnic disparities in hospitalizations for ambulatory care-sensitive conditions among dual-eligible patients and that further efforts are needed to reduce potentially avoidable emergency department visits.
Reading these articles, it is evident that Medicaid and health centers have a rich history that has dramatically and positively altered the way low income individuals are able to receive care. By eliminating barriers to access and removing health disparities at a feasible cost of service, health centers and the Medicaid program have demonstrated a powerful collaboration which must not only continue, but strengthen and evolve over the next 50 years.