Journal of Regional Medical Campuses

The Impact of the 2020 Medicaid Expansion in a Community Clinic Serving the Marshallese Population in a Rural State

Robert Brand

University of Arkansas for Medical Sciences Northwest Regional Campus

https://orcid.org/0009-0004-6215-8185

Samantha Robinson

University of Arkansas and University of Arkansas for Medical Sciences Northwest Regional Campus

https://orcid.org/0000-0002-8642-2903

Mohammod Mahmudur Rahman

University of Arkansas, University of Kansas Medical Center, and University of Arkansas for Medical Sciences Northwest Regional Campus

https://orcid.org/0009-0000-4659-9299

Alshaimaa Hazaa

University of Arkansas for Medical Sciences, Northwest Regional Campus

Sheena CarlLee

University of Arkansas for Medical Sciences Northwest Regional Campus

Hanna Jensen

University of Arkansas for Medical Sciences Northwest Regional Campus

https://orcid.org/0000-0001-8487-7982

DOI: https://doi.org/10.24926/jrmc.v7i4.6159

Keywords: Medicaid, Pacific Islander Health, Minority Health, Community Clinic, Regional Medical Campus

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Abstract

Introduction

In December of 2020, the US government passed into law a bill allowing states to enroll Compact of Free Association citizens (including citizens of the Republic of the Marshall Islands) into Medicaid. This study analyzes the impact of this expansion on the healthcare of Marshallese patients at a dedicated community clinic on a regional medical campus, serving this unique population. 

Methods

Through retrospective review of patients who utilized the community clinic either before (05/2020 to 02/2021) or after (05/2021 to 02/2022) the Medicaid expansion, this study sought to compare patients’ insurance information, number of total patients visiting the clinic, number of total patient visits, referrals per patient, and completed referrals per patient were compared between time periods.  

Results

A total of 378 patients utilized the clinic during the study period. The results demonstrated a significant increase in patient utilization of healthcare services (20.1% vs. 8.7%, p<0.01), percentage of clinic visits that included referrals (23.6% vs. 16.5%, p<0.01), and percentage of completed referrals following the Medicaid expansion (16.1% vs. 10.5%, p=0.03). Analyses of comorbidities indicated similar disease burden in both pre and post cohorts. 

Conclusion

The study’s findings suggest an increase in the use of healthcare services following the expansion of Medicaid services to previously uninsured patients. Existing literature documents the gaps in primary care services for underrepresented and uninsured populations in the United States and the significant consequences of lack of access to care. Findings from this study can aid health policymakers in designing and implementing new strategies to increase healthcare access and utilization in target populations. Future research is needed to determine how these healthcare-related behaviors affect patient health and how expanding healthcare policies may elucidate such results on a larger scale.