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How Often Do Catastrophic Injury Victims Become Medicaid Recipients?

Zaloshnja, Eduard PhD*; Miller, Ted R. PhD*; Coben, Jeffrey MD; Steiner, Claudia MD, MPH

doi: 10.1097/MLR.0b013e318245a686
Original Article

Background: People without adequate insurance may separate financially from their families and move onto Medicaid after a catastrophic injury. Medicaid then covers all of their medical care costs. No estimates for Medicaid conversions due to injury exist in the literature.

Objectives: To estimate Medicaid conversions due to injury for people 21–64 years old.

Research Design: This study analyzes the 2003 Medicaid Analytic eXtract files (the most recently available in 2009) for 14 states. For each state, we assigned a conversion cutoff date by examining the pattern of admissions after enrollment. The last day before the injury hospital admission rate decreased to its background level was considered as a cutoff date for conversions.

Subjects: Medicaid enrollees aged 21 to 64 years who received coverage due to a catastrophic injury.

Measures: Acute Medicaid conversions per 100 acute injury hospital admissions, estimated conversions remaining at least 1 year on Medicaid, and life-time public medical cost of disabled Medicaid recipients.

Results: Around 2.55% of all hospitalized injury patients not previously covered by Medicaid enrolled to cover their hospital bills. The average disabled recipient on Medicaid (possibly combined with Medicare) for 30 years has public medical payments exceeding $345,000.

Conclusions: The Medicaid postinjury enrollment policy provides important financial support to safety-net hospitals, provides better access to long-term care for trauma patients who need it, and permits states to offload costs to the federal government.

*Pacific Institute for Research and Evaluation Beltsville, Beltsville, MD

Injury Control Research Center West Virginia University Pineview Drive Morgantown, WV

Healthcare Cost and Utilization Project (HCUP) Center for Delivery, Organization and Markets (CDOM) Agency for Health Care Research and Quality (AHRQ), Rockville, MD

The authors declare no conflict of interest.

Reprints: Eduard Zaloshnja, PhD, Pacific Institute for Research and Evaluation, 11720 Beltsville Dr Suite 900, Beltsville, MD 20705. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.