Insurance Instability Among Community-Based Health Center Patients with Diabetes Post-Affordable Care Act Medicaid Expansion.

Abstract

Background: To evaluate insurance instability (churn) among adults with diabetes receiving care at community-based health centers (CHCs).

Methods: Retrospective cohort study using patients' electronic health records data for 300,158 adults aged 19 to 64 with ≥3 ambulatory visits between 2014 and 2019 of which 39,542 churned out of insurance. Generalized estimating equation-based (GEE) logistic regression models were fitted to assess the odds of churning.

Results: Among CHC patients, those with diabetes had 1.25 greater odds of churning than those without diabetes (aOR = 1.25; 95%CI = 1.18, 1.33). Among CHC patients with diabetes, the odds of churning were higher for those with uncontrolled diabetes, more complex medication regimens, and acute diabetes complication.

Conclusions: CHC patients with diabetes are more likely to experience insurance instability than those without diabetes. Outreach efforts to reduce the impact of the postpandemic Medicaid disenrollment among patients with diabetes and lower income will be critical to reduce harmful health consequences.