Disclosures: Dy reports grants from the NIH - National Center for Advancing Translational Sciences during the conduct of the study. Please see the study for all other authors’ relevant financial disclosures.
February 01, 2021
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Medicaid expansion leads to increased THA, TKA utilization

Disclosures: Dy reports grants from the NIH - National Center for Advancing Translational Sciences during the conduct of the study. Please see the study for all other authors’ relevant financial disclosures.
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According to published results, the expansion of Medicaid coverage under the Affordable Care Act has led to increased utilization of Medicaid-funded total hip and total knee arthroplasty procedures.

To analyze utilization of total joint arthroplasty before and after the Jan. 1, 2014 Medicaid expansion date, researchers at the Washington University School of Medicine in St. Louis examined 39,452 Medicaid-funded TJAs (42.1% THA, 57.9% TKA) from 2012 to 2015. They assessed utilization rates in the nine Medicaid expansion states (Arkansas, Arizona, Colorado, Iowa, Massachusetts, Maryland, Nevada, New York and Vermont), as well as two non-expansion states (Florida and Missouri).

Dy infographic
“These increases in demand should be considered by surgeons, administrators and policymakers for appropriate resource allocation.

Overall, THA and TKA procedures per 100,000 Medicaid beneciaries increased from 138.5 (before expansion, 2012-2013) to 190.7 (after expansion, 2014-2015) in the nine expansion states. Additionally, THA and TKA procedures per 100,000 Medicaid beneciaries decreased from 179.5 (before expansion, 2012-2013) to 121.1 (after expansion, 2014-2015) in the two non-expansion states, according to the study.

After controlling for geographic characteristics, researchers found THA and TKA procedures in expansion states increased 15% and 23% in 2014 and 2015, respectively, while THA and TKA procedures in non-expansion states decreased 18% and 11% in 2014 and 2015, respectively.

“These increases in demand should be considered by surgeons, administrators and policymakers for appropriate resource allocation,” the researchers wrote in the study. “The potential implications regarding access to orthopedic care should also be considered to avoid exacerbating existing disparities in delivery of care,” they added.