Community health center use after oregon’s randomized medicaid experiment

Jennifer E. DeVoe, Miguel Marino, Rachel Gold, Megan J. Hoopes, Stuart Cowburn, John Heintzman, Charles Gallia, Christine A. Nelson, Nathalie Huguet, Steffani R. Bailey

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


PURPOSE There is debate about whether community health centers (CHCs) will experience increased demand from patients gaining coverage through Affordable Care Act Medicaid expansions. To better understand the effect of new Medicaid coverage on CHC use over time, we studied Oregon’s 2008 randomized Medicaid expansion (the “Oregon Experiment”). METHODS We probabilistically matched demographic data from adults (aged 19-64 years) participating in the Oregon Experiment to electronic health record data from 108 Oregon CHCs within the OCHIN community health information network (originally the Oregon Community Health Information Network) (N = 34,849). We performed intent-to-treat analyses using zero-inflated Poisson regression models to compare 36-month (2008-2011) usage rates among those selected to apply for Medicaid vs not selected, and instrumental variable analyses to estimate the effect of gaining Medicaid coverage on use. Use outcomes included primary care visits, behavioral/mental health visits, laboratory tests, referrals, immunizations, and imaging. RESULTS The intent-to-treat analyses revealed statistically significant differences in rates of behavioral/mental health visits, referrals, and imaging between patients randomly selected to apply for Medicaid vs those not selected. In instrumental variable analyses, gaining Medicaid coverage significantly increased the rate of primary care visits, laboratory tests, referrals, and imaging; rate ratios ranged from 1.27 (95% CI, 1.05-1.55) for laboratory tests to 1.58 (95% CI, 1.10-2.28) for referrals. CONCLUSIONS Our results suggest that use of many different types of CHC services will increase as patients gain Medicaid through Affordable Care Act expansions. To maximize access to critical health services, it will be important to ensure that the health care system can support increasing demands by providing more resources to CHCs and other primary care settings.

Original languageEnglish (US)
Pages (from-to)312-320
Number of pages9
JournalAnnals of family medicine
Issue number4
StatePublished - Jan 1 2015


  • ACA
  • Community health centers
  • Health policy
  • Medicaid
  • Oregon Experiment
  • Patient protection and affordable care act
  • Practice-based research
  • Primary care utilization
  • Vulnerable populations

ASJC Scopus subject areas

  • Family Practice


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