Medicaid expansion linked to diabetes diagnosis

Diabetes diagnosis among Medicaid enrollees jumped by 23% in states that expanded the government program under the ACA, according to a study in Diabetes Care. In the states that did not expand Medicaid, the diagnosis among beneficiaries inched up by only 0.4%.

The study is based on data collected by Quest Diagnostics. The company’s researchers compared new diabetes diagnoses during the first six months of 2014, the period after Medicaid was expanded in 26 states and Washington, D.C., with new diagnoses during the first six months of 2013. Diabetes was defined as an ICD-9 diagnosis of 250.x or an HbA1c level of over 6.4%.

In the expansion states, the Quest researchers found that the number of new diagnoses in the non-Medicaid population actually decreased slightly, by -2.2%, between 2013 and 2014, in contrast to the big jump of 23.2% in the newly expanded Medicaid population. The number of new diagnoses overall increased by just 0.8%. The non-Medicaid population is about 7 times larger than the Medicaid population, so the big jump in diagnoses among Medicaid beneficiaries gets offset in the overall tally.

Change in number of patients with newly identified diabetes in Medicaid expansion states vs. nonexpansion states

*Other represents non-Medicaid patients.

Source: Kaufman HW et al., Diabetes Care, March 2015

In the nonexpansion states, it was a different story. The number of new diagnoses in the non-Medicaid population increased by 3.3%, so the new diagnoses overall increased by 2.6%, which is a larger increase than in the expansion states.

One caveat: All of these numbers come from Quest Diagnostics, and while Quest has a huge database, it is still just one company. Other sources of data, for instance information from CMS or health insurance plans, were not included.

The Quest researchers noted that the Medicaid patients with newly identified diabetes will experience better management of their disease than if diagnosis had been made later—and that should lead to fewer complications.

Well, maybe.

William C. Knowler, MD, is the chief of diabetes epidemiology and clinical research at the National Institute of Diabetes and Digestive and Kidney Diseases. He tells the New York Times what the study also mentions. Some research has shown no mortality benefit from early diagnosis of diabetes that is the result of screening.

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