# Medicaid Expansion and Quality, Utilization and Coordination of Health Care for Veterans with Chronic Kidney Disease

> **NIH VA I01** · MICHAEL E DEBAKEY VA MEDICAL CENTER · 2024 · —

## Abstract

Background: [The 2019 US Department of Health and Human Services Advancing American Kidney Health
Initiative aims to “improve care coordination…for people living with kidney disease.” Accessing care from
multiple systems and insurers can result in lapses in care coordination, and] patients with serious conditions,
such as chronic kidney disease (CKD), are especially vulnerable to poorer outcomes from fragmented care.
[While Medicaid expansion, as occurred with the Affordable Care Act (ACA),] is effective in improving access
to health care and health outcomes for the uninsured, the significant number of Veterans enrolled in VA (who
already have access to comprehensive care) who gained access to Medicaid with expansion face increased
risk of care fragmentation. Increased use of non-VA care as a result of the MISSION Act poses similar risks.]
Significance/Impact: As more Veterans access care from a mixture of VA and non-VA sources, VA needs to
adopt strategies for cross-system care coordination to ensure effective and efficient care for Veterans. This
requires understanding how Veterans utilize care when multiple options are available. Patients with advanced
CKD have highly complex care needs. Lack of well-coordinated care may increase unnecessary care and
worsen outcomes for such patients. Examining use and outcomes data will illustrate multiple aspects of access
and care coordination for Veterans with chronic conditions and anticipates implementation of the MISSION Act.
Innovation: [That some states opted out of ACA Medicaid expansion allows for a natural experiment where
changes in quality of care and utilization over time can be compared between states that did and did not
expand Medicaid. The team will use VA, Medicare, and recently-released post-expansion Medicaid claims data
to evaluate how Medicaid expansion influences Veteran choices of health system use and CKD treatment.]
Specific Aims: Aim 1: To determine the characteristics of Veterans and Veterans with CKD who are most
likely to enroll in both Medicaid and VA. Aim 2: To determine the impact of dual enrollment on the utilization of
health care services for Veterans with advanced CKD and to create a reference tool to enhance coordination
for these patients. Aim 3: To evaluate differences in quality of health care and costs among Veterans with
advanced CKD in states that have expanded Medicaid and those that have not.
Methodology: Claims data [from 17 states (7 that expanded Medicaid in 2014 and 10 that did not) in the
Medicaid Analytic eXtract (MAX) file for 2011-2014] are included. A difference-in-difference model will estimate
the association of state Medicaid expansion with [changes in Veterans’ dual-enrollment status (VA and
Medicaid) and in utilization and outcomes for Veterans with CKD. Utilization analyses will consider outpatient
visits, emergency department visits and hospital admissions recorded in VA and Medicaid data. Outcomes to
be considered are time-to-mortality, emergent ...

## Key facts

- **NIH application ID:** 10910906
- **Project number:** 5I01HX002975-04
- **Recipient organization:** MICHAEL E DEBAKEY VA MEDICAL CENTER
- **Principal Investigator:** LAURA A PETERSEN
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2021-04-01 → 2025-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10910906

## Citation

> US National Institutes of Health, RePORTER application 10910906, Medicaid Expansion and Quality, Utilization and Coordination of Health Care for Veterans with Chronic Kidney Disease (5I01HX002975-04). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10910906. Licensed CC0.

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