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Several states expanded Medicaid eligibility in 2000-2002; a large number expanded in 2014 under the Affordable Care Act (ACA). The impacts of these expansions on heart transplant (HT) candidates are unknown.
In the UNOS database, we compared 4,705 adult HT listings in 2000-2002 expansion states (AZ, NY and ME) vs control states (NV, NM, PA and NH) pre- vs post-expansion. We assessed state-level CDC trends in HF mortality. We then compared 4,586 registrations in 29 states and DC that expanded Medicaid vs 21 that did not in 2013 (pre-) and 2014 (post-ACA).
From 2000-2006, increases in Medicaid support of HT candidates in expansion states exceeded control states (p <0.0001). HF mortality fell in expansion states but rose in control states (p <0.0001). HT rates increased post-expansion but did not differ by state expansion status. State expansion and pre- vs post-expansion era interacted to predict waitlist death and post-HT death (both interaction p <0.04). The proportion of candidates with Medicaid was higher in ACA expansion states pre- and post-ACA (both p <0.001) but the effect of ACA is thus far not significant (p =0.77). LVAD use was higher for Medicaid vs other insurance (31.2% vs 26.8%, p =0.02), in expansion states (30.4% vs 23.1), and pre-ACA (30.3 vs 24.4%; both p <0.0001).
Previous Medicaid expansions are associated with increased Medicaid coverage of HT candidates and with clinical outcomes. Whether ACA's impacts will be similar merits furthers study.
Poster Area, South Hall A1
Saturday, April 02, 2016, 3:45 p.m.-4:30 p.m.
Session Title: Heart Transplant and LVADs: New Approaches to Old Issues
Abstract Category: 26. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1136-056
- 2016 American College of Cardiology Foundation