Abstract
Background
The “continuous enrollment provision” of the Families First Coronavirus Response Act
of 2020 (FFCRA) maintained states' Medicaid enrollments throughout the COVID-19 public
health emergency. This study evaluated the impact of the continuous enrollment requirement
on Medicaid patients' access to reconstructive breast surgery.
Methods
A retrospective cohort study was conducted on all patients who received reconstructive
breast surgery procedures at a large academic institution between July 1, 2013, and
July 1, 2023. The Medicaid continuous enrollment period was defined as March 18, 2020,
to July 1, 2023. Univariate analysis, multivariable logistic regression, and difference-in-difference
analysis were performed.
Results
Three thousand five hundred sixty-four patients were included, of whom 252 patients
were insured by Medicaid. Patients' odds of Medicaid insurance before and during the
continuous enrollment period did not differ (p = 0.096). The distribution of Medicaid and non-Medicaid insurance among autologous
breast reconstruction patients similarly did not differ during the continuous enrollment
period (p = 0.86). Difference-in-difference analysis confirmed that Medicaid prevalence among
autologous breast reconstruction patients did not change with the continuous enrollment
requirement (p = 0.07). Increased age was predictive of Medicaid insurance (odds ratio [OR]: 1.043;
p < 0.001); however, age-dependent differences decreased during the continuous enrollment
period. Patients with non-English language preferences had lower odds of Medicaid
insurance (OR: 0.38; p = 0.035); this difference remained unchanged with the continuous enrollment requirement
(p = 0.59).
Conclusion
The continuous enrollment requirement alleviated certain age-dependent barriers for
Medicaid patients but may not have addressed other patient-level, system-level, and
procedure-specific barriers to reconstructive breast surgery.
Keywords
Medicaid - health policy - breast
