Some people who experience a traumatic spinal cord injury (SCI) need hospital treatment and intensive rehabilitation therapy to achieve a full recovery. Many SCI patients living in the United States access these services using Medicaid, a publicly funded health insurance provider for low-income people and people with disabilities. Unfortunately, people who rely on Medicaid face significant disparities in health care access and outcomes—Medicaid coverage is limited to certain basic services, physicians are less likely to take on Medicaid patients than privately insured patients, and people of low socioeconomic status generally are more likely to experience poor health outcomes.
In West Virginia, one of the lowest-resource states in the country, nearly one-third of adult residents rely on Medicaid as their primary payer (compared to the national average of 18.9%). Despite widespread dependence on publicly funded insurance, West Virginia Medicaid fails to provide coverage for inpatient medical rehabilitation, rendering many people with SCI and other traumatic injuries unable to access essential therapeutic services.
Health care providers are concerned that people with SCI who use Medicaid may suffer from poor health outcomes as a result of high costs of care and lack of access to services. To increase the existing body of knowledge about the relationship between Medicaid and health outcomes, a research team at West Virginia University conducted a study of 200 adults who were admitted to a West Virginia trauma center since 2009. The researchers collected data about each patient’s injuries, insurance type, length of hospital stay, and care costs. They found that:
- About 28% of SCI patients were Medicaid beneficiaries. On average, the Medicaid patients were younger (37 years) than non-Medicaid patients (50 years).
- Compared to privately insured patients, Medicaid patients had a significantly longer stay in the hospital. After their stay, they were much more likely to be sent home or discharged to a nursing facility rather than an acute rehabilitation center.
- Although injury severity did not differ between Medicaid and non-Medicaid patients, those who rely on Medicaid received much higher hospital bills ($203,264) than those with private insurance ($140,114).
Although Medicaid is intended to provide health coverage for low-income families, West Virginian SCI patients who rely on Medicaid tend to experience significant health care disparities compared to privately insured patients, including longer hospital stays and higher hospital bills. Furthermore, Medicaid patients are unlikely to be discharged to an acute rehabilitation center, limiting their access to the therapeutic services they need to make a fuller recovery. These findings indicate an urgent need to expand Medicaid benefits to cover inpatient medical rehabilitation services, including efforts to open more rehabilitation facilities for Medicaid beneficiaries.
Sedney CL, Khan U, & Dekeseredy P. Traumatic spinal cord injury in West Virginia: Disparities by insurance and discharge disposition from an acute care hospital. Spinal Cord Medicine. (2020).