Health Care Access and Receipt of Clinical Diabetes Preventive Care for Working-Age Adults With Diabetes in States With and Without Medicaid Expansion: Results from the 2013 and 2015 BRFSS

Objective: This study aimed to assess whether the recent Medicaid expansion, as a natural experiment, was associated with better access to care and, as a consequence, better receipt of clinical diabetes care services. Methods: Data were from the Behavioral Risk Factor Surveillance System (BRFSS). The analytical sample included 20 708 working-age adults with diabetes aged 18 to 64 years from 22 states. The outcome variables included 4 measures of access to care and 4 measures of receipt of clinical diabetes care services. A difference-in-difference logistic regression model was used to compare changes in outcomes between respondents in Medicaid expansion and nonexpansion states. Data from the 2013 survey provided pre-Medicaid expansion information, and data from the 2015 survey provided postexpansion information. Analyses were conducted using Stata 13 using survey commands to account for the complex survey design of BRFSS. Results: A significant increase was observed in health insurance coverage for people with diabetes from 2013 to 2015 (P <.05) in both Medicaid expansion and nonexpansion states, with a larger increase in the Medicaid expansion states. The Time by Medicaid expansion interaction term was significant for 2 measures of access to care: health insurance coverage (adjusted odds ratio [AOR] = 1.43, 95% confidence interval: 1.04-1.96) and having an annual checkup (AOR = 1.30, 95% confidence interval: 1.00-1.71). Respondents in expansion states were more likely to have a personal doctor and more likely to be able to afford a physician visit than those in nonexpansion states. The Time by Medicaid expansion was close to significance for one of the measures of clinical diabetes care: getting flu shots (AOR = 1.20, P =.08). Conclusions: Medicaid expansion did improve health care access but no significant improvement was found for receipt of clinical diabetes care for people with diabetes. Resources provided through Medicaid are vital for diabetes control and management.