Black Medicaid enrollees face higher preventable hospitalization rates, report finds

Black Medicaid enrollees are more likely than their white counterparts—even those with low incomes and disabilities—to be hospitalized for preventable health events relating to heart failure, diabetes, and asthma/chronic obstructive pulmonary disease (COPD), according to a new analysis.

Nonprofit think tank Urban Institute researchers, with support from the Robert Wood Johnson Foundation, looked at preventable hospitalizations—or inpatient stays that could have been avoided with “timely and high-quality” primary care—among roughly 5 million Medicaid enrollees across 21 states between 2018 and 2019.

The researchers found that overall, enrollees with disabilities and incomes that qualified them for Medicaid via Supplemental Security Income (SSI) status faced higher rates of preventable hospitalizations than non-SSI enrollees for heart failure (9.4% versus 5.2%), diabetes (4.0% versus 2.5%), and asthma/COPD (3.4% versus 1.1%). Though, the researchers wrote in the analysis, enrollees with a disability may already “be at an increased risk of hospitalization because of underlying health conditions associated with their disability.”

Still, Black enrollees had higher rates of preventable hospitalizations—which cost the US health system an estimated $33+ billion each year—regardless of their SSI status, according to the report.

Nearly 13% of about 22,550 Black Medicaid SSI patients previously diagnosed with heart failure had more preventable hospitalizations (versus 7.2% of 19,858 white SSI Medicaid enrollees), researchers found. Meanwhile, 6.9% of Black non-SSI Medicaid patients (10,503 people) had more preventable heart failure-related hospitalizations compared to 3.6% of white non-SSI enrollees (17,229 people).

Black Medicaid patients also faced higher preventable hospitalization rates than their white counterparts for diabetes and COPD/asthma, according to the report.

Katherine Hempstead, a Robert Wood Johnson Foundation senior policy advisor, argued that the findings for heart failure “are particularly concerning.”

“[T]hey show high overall rates, as well as large differences by race and disability status, suggesting that enrollees lack sufficient access to high-quality primary care, particularly enrollees that are Black and/or disabled,” she said in a statement.

Claire O’Brien, an Urban Institute research analyst, added that the findings “suggest a need to improve access to outpatient care to effectively manage chronic conditions.”