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Utilization of Community Health Centers in Medicaid Expansion and Nonexpansion States, 2013–2014

Hoopes, Megan J. MPH; Angier, Heather MPH; Gold, Rachel PhD, MPH; Bailey, Steffani R. PhD; Huguet, Nathalie PhD; Marino, Miguel PhD; DeVoe, Jennifer E. MD, DPhil

Journal of Ambulatory Care Management: October/December 2016 - Volume 39 - Issue 4 - p 290–298
doi: 10.1097/JAC.0000000000000123
Original Articles

Using electronic health record data, we examined longitudinal changes in community health center (CHC) visit rates from 2013 through 2014 in Medicaid expansion versus nonexpansion states. Visits from 219 CHCs in 5 expansion states and 4 nonexpansion states were included. Rates were computed using generalized estimating equation Poisson models. Rates increased in expansion state CHCs for new patient, preventive, and limited-service visits (14%, 41%, and 23%, respectively, P < .01 for all), whereas these rates remained unchanged in nonexpansion states. One year after ACA Medicaid expansions, CHCs in expansion states saw an influx of new patients and provided increased preventive services.

OCHIN, Inc, Portland, Oregon (Ms Hoopes); Oregon Health and Science University, Portland, Oregon (Ms Angier, Dr Bailey, Dr Huguet, Dr Marino, and Dr DeVoe)

Kaiser Permanente Northwest Center for Health Research, OCHIN, Inc, Portland, Oregon (Dr Gold).

Correspondence: Megan J. Hoopes, MPH, OCHIN, Inc, 1881 SW Naito Parkway, Portland, OR 97201 (

This work was financially supported by the Patient-Centered Outcomes Research Institute (PCORI) Health Systems Cycle I (2012), the National Cancer Institute (NCI) of the National Institutes of Health, grant number (1 R01 CA181452 01), The Agency for Healthcare Research and Quality (AHRQ), grant number (R01HS024270) and the Oregon Health & Science University Department of Family Medicine. We thank the OCHIN practice-based research network (PBRN) and all clinics in the PBRN for making this research possible.

The authors have no conflicts of interest to report.

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