According to study results presented during the American Diabetes Association’s 80th Scientific Sessions, held online June 12-16, Medicaid expansion under the Affordable Care Act (ACA) is associated with significant reductions in major lower-limb amputations among racial and ethnic minority patients with diabetic foot ulcers (DFUs) between 2013 and 2015.
Using information from State Inpatient Databases, researchers included 25,493 minority Medicaid beneficiaries and 9,863 patients without insurance from 19 states, which were categorized as either an early-adopter or nonadopter state based on their implementation of the ACA expansion by January 2014.
In the early-adopter states, there was a 180.7 percent increase in the number of inpatient admissions for Medicare beneficiaries after expansion. These states also had a 21.5 percent decrease in admissions for uninsured patients. Alternatively, the states that did not implement Medicaid expansion had a 78.2 percent increase in the number of inpatient admissions for uninsured patients.
With regard to lower-limb amputations, the odds of major amputation decreased by 17.3 percent among minority Medicare beneficiaries with diabetic foot ulcers in the early-adopter states and increased by 0.9 percent in states that did not expand Medicare. Conversely, the odds of minor amputations increased by 14 percent in the early-adopter states, but decreased by 8.1 percent in the states that did not expand Medicare coverage.
