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Veterans’ Reliance on VA Care by Type of Service and Distance to VA for Nonelderly VA-Medicaid Dual Enrollees

Yoon, Jean, PhD, MHS*,†,‡; Vanneman, Megan E., PhD, MPH§,∥,¶; Dally, Sharon K., MS*; Trivedi, Amal N., MD, MPH#,**; Phibbs, Ciaran S., PhD*,†,††

doi: 10.1097/MLR.0000000000001066
Brief Report

Background: Not much is known about nonelderly veterans and their reliance on care from the Veterans Affairs (VA) health care system when they have access to non-VA care.

Objectives: To estimate VA reliance for nonelderly veterans enrolled in VA and Medicaid.

Research Design: Retrospective, longitudinal analysis of Medicaid claims data and VA administrative data to compare patients’ utilization of VA and Medicaid services 12 months before and for up to 12 months after Medicaid enrollment began.

Subjects: Nonelderly veterans (below 65 y) receiving VA care and newly enrolled in Medicaid, calendar years 2006–2010 (N=19,890).

Measures: VA reliance (proportion of care received in VA) for major categories of outpatient and inpatient care.

Results: Patients used VA outpatient care at similar levels after enrolling in Medicaid with the exceptions of emergency department (ED) and obstetrics/gynecology care, which decreased. VA inpatient utilization was similar after Medicaid enrollment for most types of care. VA-adjusted outpatient reliance was highest for mental health care (0.99) and lowest for ED care (0.02). VA-adjusted inpatient reliance was highest for respiratory (0.80) and cancer stays (0.80) and lowest for musculoskeletal stays (0.20). Associations between VA reliance and distance to VA providers varied by type of care.

Conclusions: Veterans dually enrolled in Medicaid received most of their outpatient care from the VA except ED, obstetrics/gynecology, and dental care. Patients received most of their inpatient care from Medicaid except mental health, respiratory, and cancer care. Sensitivity to travel distance to VA providers explained some of these differences.

*Health Economics Resource Center

Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park

Department of General Internal Medicine, UCSF School of Medicine, San Francisco, CA

§Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT

Departments of Internal Medicine, Division of Epidemiology

Population Health Sciences, Division of Health System Innovation and Research, University of Utah School of Medicine, Salt Lake City, UT

#Providence VA Medical Center

**Department of Health Services, Policy, and Practice, Brown University, Providence, RI

††Department of Pediatrics, Stanford University School of Medicine, Stanford, CA

This work was supported by Merit Review Award # IHX001463A from the US Department of Veterans Affairs, Health Services Research, and Development Service. M.E.V. would like to acknowledge research support from the VA Office of Academic Affiliations as well as the University of Utah Health Enhancing Development-Generating Excellence (EDGE) Scholar and Vice President’s Clinical and Translational Scholars (VPCA) programs. Support for VA/CMS data were provided by the Department of Veterans Affairs, VA Health Services Research and Development Service, VA Information Resource Center (Project Numbers SDR 02-237 and 98-004).

The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.

The authors declare no conflict of interest.

Reprints: Jean Yoon, PhD, MHS, Health Economics Resource Center, VA Palo Alto Health Care System, 795 Willow Road, 152-MPD, Menlo Park, CA 94025. E-mail:

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