Primary care utilization and clinical quality performance: a comparison between health centres in Medicaid expansion states and non-expansion states

Objectives: The United States Government’s Medicaid expansion policy has important implications for health centres, since a large proportion of health centre patients are Medicaid enrollees. The objective of this study was to compare primary care utilization and clinical quality performance between health centres in Medicaid expansion states and those in Medicaid non-expansion states. Methods: We conducted a cross-sectional study. Multiple regressions, using a standard linear model, were performed to examine the relationship between Medicaid expansion status and performance measures, accounting for covariates. Results: Our results showed that in unadjusted analyses, health centres in Medicaid expansion states reported larger number of patients served, larger number of medical visits, a higher percentage of Medicaid patients, and better performance in seven of 16 clinical quality measures than those in Medicaid non-expansion states. After controlling for relevant health centre-level covariates, the differences in mean patients served, mean medical visits, percentage of Medicaid patients, and five clinical quality measures still existed. Conclusions: These findings reveal significant associations between Medicaid expansion and primary care utilization and the quality of care. Medicaid expansion has demonstrated its potential role in promoting primary care for vulnerable populations served by health centres.