Elliott, Roxanne M. and Everhart, Jeannine and Lovern, Stephen W. and Carter, Rebecca W. Critical Access Hospital Closures in Medicaid Expansion and Non-Expansion States: Exploring County-Level Variables as Associated with Closures. 2023. Radford University, Doctoral Capstone Project. Radford University Scholars' Repository.
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Abstract
As part of the Affordable Care Act, states were provided the option to expand access to health care coverage by adopting to expand Medicaid resulting in increased access to health care coverage. Even with this policy change, critical access and rural hospitals continue to close with 210 hospitals being deemed at extreme risk of closure (NRHA, 2016). Hospital closures are devastating to rural communities and impact access to care, health disparities, health outcomes, and economic stability in the communities (Corcoran et al., 2019; Holmes, 2015; Lindrooth et al., 2018; Mason, 2017; Reiter et al., 2015; Thomas et al., 2015). Critical Access Hospitals (CAH) serve as a safety net for care delivery in rural communities. From 2010-2020 there were 25 CAHs that completely closed (UNC Cecil G. Sheps Center, n.d.). This mixed methods study explored the impact of state’s decision to expand or not expand Medicaid on CAH closures. The study also analyzed facility and county-level variables that may correlate with closed CAHs in expansion versus non-expansion states. Furthermore, qualitative data was used to clarify the secondary data findings. The variables included annual average daily census, population shift from 2010-2020, population of 65 plus, population of uninsured, population of non-White, population of Hispanic/Latino, and population living at the federal poverty level. Using independent t-tests and independent Mann-Whitney U-tests, the results of the study found one statistically significant variable. The percent of population uninsured was statistically significant, t = 2.31, p = 0.030, for the percent of population that was uninsured in expansion (M = 11.56, SD = 4.18) and non-expansion (M = 15.69, SD = 3.43) states. Although percent of population age 65 plus and percent of population shift were not statistically significant, there were medium and large effect sizes (d=0.572 and d=0.880), which indicate a potential for correlation. Other findings include that 20 of the CAH closures were in non-expansion versus five in expansion states and 88 percent of the closures were in Southern states. Qualitative data demonstrated themes to include the need to close the revenue gap, the impact of internal and external relationships on closures, lack of resources to grow services, and the need to engage in collaborative service expansion. This study supports that policies, county-level variables, and organizational practices can impact the stability of a CAH. Keywords: Medicaid expansion, critical access hospitals, rural health care challenges, closed hospitals
| Item Type: | Doctoral Capstone Project |
|---|---|
| Additional Information: | None |
| Uncontrolled Keywords: | Medicaid expansion, critical access hospitals, rural health care challenges, closed hospitals |
| Subjects: | R Medicine > RZ Other systems of medicine |
| Divisions: | Radford University > Waldron College of Health and Human Services > Health Sciences Program |
| Date Deposited: | 01 Aug 2023 21:59 |
| Last Modified: | 01 Aug 2023 21:59 |
| URI: | http://wagner.radford.edu/id/eprint/1029 |
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- Critical Access Hospital Closures in Medicaid Expansion and Non-Expansion States: Exploring County-Level Variables as Associated with Closures. (deposited 01 Aug 2023 21:59) [Currently Displayed]
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