Effects of Medicaid Expansion on Perceived Community Health Needs: Comparing and Contrasting the Content of CAH CHNAs Nationwide

Theoretical Background and research questions/hypothesis:

The Patient Protection and Affordable Care Act (ACA) of 2010 included a requirement that every nonprofit hospital complete a Community Health Needs Assessment (CHNA) every three years. At the same time, the ACA offered significant financial incentives for states to broaden access to their Medicaid programs. Not all states took advantage of the Medicaid expansion incentives.. The question explored in this study is: Do critical access hospital community health needs assessments in Medicaid expansion states report different community health care needs than those in non-expansion states?

Methods:

A list of rural, critical access hospitals nationwide was obtained from the Rural Health Information Hub Data Explorer (2020) and used as the starting point for this study’s sampling process. A random selection was made from that list, with the goal of recording the content of 20% of each state’s CAHs. Despite the IRS regulation including a requirement for making the CHNA publicly accessible, many hospitals did not publish a link to their report on their website. In that case, random draws of that state’s facilities were continued until the 20% goal for each state was achieved.

Results:

Both descriptive and analytic statistics indicate there are some differences between states, but there are also universal concerns in rural communities served by CAHs nationwide, regardless of Medicaid expansion status.

Conclusions: Comparing the CNHAs for rural CAHs in Medicaid expansion and non-Medicaid expansion states highlights the commonality of rural community member healthcare concerns more than the differences. No matter the policy orientation of the state government, members of rural communities share concerns about accessing mental health services and substance misuse issues, about managing the cost of healthcare, about helping community members cope with chronic diseases, and about workaday issues such as simply being able to get to healthcare providers.

Implications for research and/or practice: . No matter the policy orientation of the state government, members of rural communities share concerns about accessing mental health services and substance misuse issues, about managing the cost of healthcare, about helping community members cope with chronic diseases, and about workaday issues such as simply being able to get to healthcare providers. More than 13 years after the Affordable Care Act, community health needs assessments demonstrate there is still a very large gap between provided healthcare services and what rural community members feel they need.