PT  - JOURNAL ARTICLE
AU  - Jennifer E. DeVoe
AU  - Miguel Marino
AU  - Rachel Gold
AU  - Megan J. Hoopes
AU  - Stuart Cowburn
AU  - Jean P. O’Malley
AU  - John Heintzman
AU  - Charles Gallia
AU  - K. John McConnell
AU  - Christine A. Nelson
AU  - Nathalie Huguet
AU  - Steffani R. Bailey
TI  - Community Health Center Use After Oregon’s Randomized Medicaid Experiment
AID  - 10.1370/afm.1812
DP  - 2015 Jul 01
TA  - The Annals of Family Medicine
PG  - 312--320
VI  - 13
IP  - 4
4099  - http://www.annfammed.org/content/13/4/312.short
4100  - http://www.annfammed.org/content/13/4/312.full
SO  - Ann Fam Med2015 Jul 01; 13
AB  - PURPOSE There is debate about whether community health centers (CHCs) will experience increased demand from patients gaining coverage through Affordable Care Act Medicaid expansions. To better understand the effect of new Medicaid coverage on CHC use over time, we studied Oregon’s 2008 randomized Medicaid expansion (the “Oregon Experiment”).METHODS We probabilistically matched demographic data from adults (aged 19–64 years) participating in the Oregon Experiment to electronic health record data from 108 Oregon CHCs within the OCHIN community health information network (originally the Oregon Community Health Information Network) (N = 34,849). We performed intent-to-treat analyses using zero-inflated Poisson regression models to compare 36-month (2008–2011) usage rates among those selected to apply for Medicaid vs not selected, and instrumental variable analyses to estimate the effect of gaining Medicaid coverage on use. Use outcomes included primary care visits, behavioral/mental health visits, laboratory tests, referrals, immunizations, and imaging.RESULTS The intent-to-treat analyses revealed statistically significant differences in rates of behavioral/mental health visits, referrals, and imaging between patients randomly selected to apply for Medicaid vs those not selected. In instrumental variable analyses, gaining Medicaid coverage significantly increased the rate of primary care visits, laboratory tests, referrals, and imaging; rate ratios ranged from 1.27 (95% CI, 1.05–1.55) for laboratory tests to 1.58 (95% CI, 1.10–2.28) for referrals.CONCLUSIONS Our results suggest that use of many different types of CHC services will increase as patients gain Medicaid through Affordable Care Act expansions. To maximize access to critical health services, it will be important to ensure that the health care system can support increasing demands by providing more resources to CHCs and other primary care settings.