THE IMPACT OF THE FIRST FAMILY CORONAVIRUS RESPONSE ACT ON HEALTHCARE SERVICE UTILIZATION AMONG MEDICAID BENEFICIARIES WITH SICKLE CELL DISEASE IN WISCONSIN
Author(s)
Maryam Imam, B. Pharm, MS1, Amanda Brandow, DO, MS2, Carissa Tomas, MS, PhD1, Susan, E Creary, DO, MS3, Joni, S Williams, MD, MPH4, Jeff Huebner, MD5, Ashima Singh, MS, PhD2;
1Medical college of Wisconsin, Institute of Health and Humanity, Milwaukee, WI, USA, 2Medical College of Wisconsin, Department of Hematology and Bone Marrow Transplant, Milwaukee, WI, USA, 3National Children’s Hospital, Center for Child Health Equity and Outcomes Research, Philadelphia, PA, USA, 4Medical College of Wisconsin, Center for Advancing Population Science (CAPS), Milwaukee, WI, USA, 5Wisconsin Medicaid Program, Department of Health Services, Madison, WI, USA
1Medical college of Wisconsin, Institute of Health and Humanity, Milwaukee, WI, USA, 2Medical College of Wisconsin, Department of Hematology and Bone Marrow Transplant, Milwaukee, WI, USA, 3National Children’s Hospital, Center for Child Health Equity and Outcomes Research, Philadelphia, PA, USA, 4Medical College of Wisconsin, Center for Advancing Population Science (CAPS), Milwaukee, WI, USA, 5Wisconsin Medicaid Program, Department of Health Services, Madison, WI, USA
OBJECTIVES: Sickle cell disease (SCD) requires consistent care and access to achieve optimal outcomes. Prior studies show that only 60-70% of individuals with SCD maintain continuous Medicaid enrollment over three years. The Families First Coronavirus Response Act (FFCRA) facilitated uninterrupted Medicaid coverage during COVID-19. This study examines FFCRA’s impact on healthcare service utilization among individuals with SCD. We hypothesize that individuals with prior coverage gaps have reduced acute care utilization (emergency department (ED) and inpatient visits) during the FFCRA period.
METHODS: We used Medicaid claims data from the Sickle Cell Data Collection Program in Wisconsin. The cohort included individuals of all ages with three or more SCD claims over a 5-year period who had Medicaid coverage gaps during 2017-2019 (pre-FFCRA) and at least 1 year of observation in both the pre-FFCRA (2017-2019) and post-FFCRA (2021-2022) periods. We compared ED, inpatient, and outpatient (including telehealth) visit rates between periods using generalized estimating equations with Poisson distribution. Visit types were identified based on Centers for Medicare and Medicaid place-of-service codes.
RESULTS: We identified 142 eligible individuals (all ages) with SCD who had gaps in Medicaid coverage pre-FFCRA (mean age (SD)=20.96(14.3), 51.4% females, 83.5% Black). ED visits significantly decreased from 5.91 (95% CI: 4.50-7.33) to 3.39 (95% CI: 2.60-4.17) visits/person/year from pre- to post-FFCRA. Similarly, inpatient visits declined from 1.7 (95% CI: 1.14-2.27) to 0.9 (95% CI: 0.58-1.17) visits/person/year. There were no significant differences in outpatient visits pre- vs. post-FFCRA (21.0 (95% CI: 12.63-29.31) (95% CI: 9.54-31.26) p-value=0.8641). After adjustment for age, disability status, and sex, FFCRA effects remained unchanged
CONCLUSIONS: Findings suggest that continuous Medicaid coverage may be a potential strategy to reduce acute visits for individuals with SCD, though the underlying mechanisms are not clear. Further research is needed to assess whether legislation sustaining continuous enrollment could improve outcomes in this vulnerable population.
METHODS: We used Medicaid claims data from the Sickle Cell Data Collection Program in Wisconsin. The cohort included individuals of all ages with three or more SCD claims over a 5-year period who had Medicaid coverage gaps during 2017-2019 (pre-FFCRA) and at least 1 year of observation in both the pre-FFCRA (2017-2019) and post-FFCRA (2021-2022) periods. We compared ED, inpatient, and outpatient (including telehealth) visit rates between periods using generalized estimating equations with Poisson distribution. Visit types were identified based on Centers for Medicare and Medicaid place-of-service codes.
RESULTS: We identified 142 eligible individuals (all ages) with SCD who had gaps in Medicaid coverage pre-FFCRA (mean age (SD)=20.96(14.3), 51.4% females, 83.5% Black). ED visits significantly decreased from 5.91 (95% CI: 4.50-7.33) to 3.39 (95% CI: 2.60-4.17) visits/person/year from pre- to post-FFCRA. Similarly, inpatient visits declined from 1.7 (95% CI: 1.14-2.27) to 0.9 (95% CI: 0.58-1.17) visits/person/year. There were no significant differences in outpatient visits pre- vs. post-FFCRA (21.0 (95% CI: 12.63-29.31) (95% CI: 9.54-31.26) p-value=0.8641). After adjustment for age, disability status, and sex, FFCRA effects remained unchanged
CONCLUSIONS: Findings suggest that continuous Medicaid coverage may be a potential strategy to reduce acute visits for individuals with SCD, though the underlying mechanisms are not clear. Further research is needed to assess whether legislation sustaining continuous enrollment could improve outcomes in this vulnerable population.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EPH118
Topic
Epidemiology & Public Health
Topic Subcategory
Public Health
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Rare & Orphan Diseases