Impact of the Affordable Care Act on Providing Equitable Healthcare Access for IBD in the Kentucky Appalachian Region

Jennifer T. Castle, Brittany E. Levy, Anthony A. Mangino, Hannah G. McDonald, Erin E. McAtee, Jitesh A. Patel, B. Mark Evers, Avinash S. Bhakta

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


BACKGROUND: Medicaid expansion improved insurance coverage for patients with chronic conditions and low income. The effect of Medicaid expansion on patients with IBD from high-poverty communities is unknown. OBJECTIVE: This study aimed to evaluate the impact of Medicaid expansion in Kentucky on care for patients with IBD from the Eastern Kentucky Appalachian community, a historically impoverished area. DESIGN: This study was a retrospective, descriptive, and ecological study. SETTINGS: This study was conducted in Kentucky using the Hospital Inpatient Discharge and Outpatient Services Database. PATIENTS: All encounters for IBD care for 2009-2020 for patients from the Eastern Kentucky Appalachian region were included. MAIN OUTCOME MEASURES: The primary outcomes measured were proportions of inpatient and emergency encounters, total hospital charge, and hospital length of stay. RESULTS: Eight hundred twenty-five preexpansion and 5726 postexpansion encounters were identified. Postexpansion demonstrated decreases in the uninsured (9.2%-1.0%; p < 0.001), inpatient encounters (42.7%-8.1%; p < 0.001), emergency admissions (36.7%-12.3%; p < 0.001), admissions from the emergency department (8.0%-0.2%; p < 0.001), median total hospital charge ($7080-$3260; p < 0.001), and median total hospital length of stay (4-3 days; p < 0.001). Similarly, postexpansion demonstrated increases in Medicaid coverage (18.8%-27.7%; p < 0.001), outpatient encounters (57.3%-91.9%; p < 0.001), elective admissions (46.9%-76.2%; p < 0.001), admissions from the clinic (78.4%-90.2%; p < 0.001), and discharges to home (43.8%-88.2%; p < 0.001). LIMITATIONS: This study is subject to the limitations inherent in being retrospective and using a partially de-identified database. CONCLUSION: This study is the first to demonstrate the changes in trends in care after Medicaid expansion for patients with IBD in the Commonwealth of Kentucky, especially Appalachian Kentucky, showing significantly increased outpatient care utilization, reduced emergency department encounters, and decreased length of stays.

Original languageEnglish
Pages (from-to)1273-1281
Number of pages9
JournalDiseases of the Colon and Rectum
Issue number9
StatePublished - Sep 1 2023

Bibliographical note

Funding Information:
Funding/Support : Jennifer T. Castle is funded by the National Institutes of Health training (grant T32CA160003). The project described was supported by the National Institutes of Health National Center for Advancing Translational Sciences (grant UL1TR001998).

Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.


  • Affordable Care Act
  • Health care utilization
  • Medicaid expansion

ASJC Scopus subject areas

  • Gastroenterology


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