In the Journals

Medicaid expansion states see 66% increase in covered kidney transplants

Meera N. Harhay

States that implemented Medicaid expansion under the Affordable Care Act saw greater increases in covered preemptive kidney transplants than did non-expansion states, according to a recently published study.

“Preemptive kidney transplantation, or kidney transplantation before the need for dialysis, is the preferred treatment for end-stage kidney disease,” Meera N. Harhay, MD, MSCE, associate professor of medicine at Drexel University College of Medicine, and colleagues wrote. “However, the lack of affordable health insurance in the United States is a known barrier to preemptive kidney transplantation for low-income individuals with ESKD, as Medicare benefits are reserved for older adults, the permanently disabled and those who are dialysis-dependent. Several U.S. states have expanded Medicaid under the Patient Protection and ACA, extending Medicaid coverage to millions of previously uninsured low-income individuals including those with nondialysis-dependent kidney disease.”

Researchers sought to determine whether Medicaid expansion was associated with changes in Medicaid coverage for preemptive living and deceased donor kidney transplantation. Using national data from the Organ Procurement and Transplantation Network, they conducted a retrospective study of 15,775 adults aged between 21 and 64 years who received a preemptive kidney transplant from January 2010 to December 2017 (median age, 51 years; 56% were men; 71% were white).

Considering the proportion of transplants that were covered by Medicaid, pre- and post-implementation periods in Medicaid expansion states were compared with the periods before and after Jan. 1, 2014 in non-expansion states. Researchers found that, from pre- to post- expansion period, preemptive kidney transplantation with Medicaid coverage increased relatively by 66% in expansion states vs. 37% in non-expansion states. In addition, the proportion of preemptive deceased donor kidney transplants with Medicaid-coverage increased by 0.8% in non-expansion states and by 3.8% in expansion states.

calculator that says Medicaid on top of money 
States that implemented Medicaid expansion under the Affordable Care Act saw greater increases in covered preemptive kidney transplants than did non-expansion states.
Source: Adobe Stock

For living kidney donor transplants, those covered by Medicaid increased by 0.7% in non-expansion states and 2.2% in expansion states.

Researchers also noted that, after expansion, Medicaid-covered preemptive kidney transplant recipients from expansion states were more likely to be minorities than those from non-expansion states (51.1% minorities vs. 47.6%).

“These findings extend our prior work showing that Medicaid expansion was associated with a 59% relative increase in Medicaid-covered preemptive kidney transplantation wait-listings,” the researchers wrote. “Preemptive kidney transplantation allows individuals with ESKD to avoid the morbidity and mortality associated with dialysis. These results suggest that Medicaid expansion has enabled more low-income U.S. individuals with chronic kidney disease to receive kidney transplantation before requiring dialysis.”– by Melissa J. Webb

Disclosures: The authors report no relevant financial disclosures.

Meera N. Harhay

States that implemented Medicaid expansion under the Affordable Care Act saw greater increases in covered preemptive kidney transplants than did non-expansion states, according to a recently published study.

“Preemptive kidney transplantation, or kidney transplantation before the need for dialysis, is the preferred treatment for end-stage kidney disease,” Meera N. Harhay, MD, MSCE, associate professor of medicine at Drexel University College of Medicine, and colleagues wrote. “However, the lack of affordable health insurance in the United States is a known barrier to preemptive kidney transplantation for low-income individuals with ESKD, as Medicare benefits are reserved for older adults, the permanently disabled and those who are dialysis-dependent. Several U.S. states have expanded Medicaid under the Patient Protection and ACA, extending Medicaid coverage to millions of previously uninsured low-income individuals including those with nondialysis-dependent kidney disease.”

Researchers sought to determine whether Medicaid expansion was associated with changes in Medicaid coverage for preemptive living and deceased donor kidney transplantation. Using national data from the Organ Procurement and Transplantation Network, they conducted a retrospective study of 15,775 adults aged between 21 and 64 years who received a preemptive kidney transplant from January 2010 to December 2017 (median age, 51 years; 56% were men; 71% were white).

Considering the proportion of transplants that were covered by Medicaid, pre- and post-implementation periods in Medicaid expansion states were compared with the periods before and after Jan. 1, 2014 in non-expansion states. Researchers found that, from pre- to post- expansion period, preemptive kidney transplantation with Medicaid coverage increased relatively by 66% in expansion states vs. 37% in non-expansion states. In addition, the proportion of preemptive deceased donor kidney transplants with Medicaid-coverage increased by 0.8% in non-expansion states and by 3.8% in expansion states.

calculator that says Medicaid on top of money 
States that implemented Medicaid expansion under the Affordable Care Act saw greater increases in covered preemptive kidney transplants than did non-expansion states.
Source: Adobe Stock

For living kidney donor transplants, those covered by Medicaid increased by 0.7% in non-expansion states and 2.2% in expansion states.

Researchers also noted that, after expansion, Medicaid-covered preemptive kidney transplant recipients from expansion states were more likely to be minorities than those from non-expansion states (51.1% minorities vs. 47.6%).

“These findings extend our prior work showing that Medicaid expansion was associated with a 59% relative increase in Medicaid-covered preemptive kidney transplantation wait-listings,” the researchers wrote. “Preemptive kidney transplantation allows individuals with ESKD to avoid the morbidity and mortality associated with dialysis. These results suggest that Medicaid expansion has enabled more low-income U.S. individuals with chronic kidney disease to receive kidney transplantation before requiring dialysis.”– by Melissa J. Webb

Disclosures: The authors report no relevant financial disclosures.

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