Factors contributing to long term Medicaid sustainment among burn patients enrolled via California's Hospital Presumptive Eligibility program.

Abstract

Background: Hospital Presumptive Eligibility (HPE) provides uninsured patients temporary Medicaid coverage at the time of hospitalization and offers a pathway to securing long term Medicaid coverage in California. This is of particular importance for burn survivors who have ongoing healthcare needs and may experience financial hardship due to acute and long-term recovery service utilization.

Methods: Using Medicaid claims eligibility data, the California Department of Health Care Services Management Information Systems and the Decisions Support System records, patients ages 18-64 with a primary diagnosis of burn were identified. Descriptive characteristics and Pearson's χ2 tests were used to evaluate bivariate relationships between those who sustained Medicaid after 6 months and those who did not. Multivariate logistic regression was used to determine association of various factors with Medicaid sustainment.

Results: Of 1382 included patients, 73% sustained Medicaid 6 months after HPE enrollment. There were significant differences in Medicaid sustainment between race/ethnicity groups, primary language, total burn surface area (TBSA), length of inpatient stay, and need for mechanical ventilation (p=.008) indicating intensive care unit (ICU) admission. For those who were discharged, multivariate analyses show Spanish speakers and those who did not disclose their language vs. English speakers (p=.020 and p<.001 respectively), those who did not disclose race/ethnicity vs. white (p=.017), those with <10% TBSA vs 20 + % TBSA (p<.001), and those who were discharged home vs. those discharged to services (p=.047) were less likely to sustain Medicare. Similar results were observed for all inpatients, except those without concurrent trauma (p=.042) were also less likely to sustain Medicaid.

Conclusions: HPE enrollment at the time of burn injury hospitalization provides a viable path for patients to obtain long term Medicaid insurance, but additional support pathways must be identified to support Medicaid sustainment for those who are not English speakers and those who are less likely to require long term follow up care (i.e., those with lower TBSA and those who are discharged home).