Medicaid's role in critical care after Medicaid expansion: evidence from Virginia.

Introduction: Medicaid provides access to care for low-income patients facing life-threatening illnesses who are cared for in intensive care units (ICUs). Despite the growth of Medicaid coverage with the Affordable Care Act, little is known about Medicaid's role in critical care for the Medicaid Expansion population, adults ages 19-64. Methods: Using hospital discharge data from Virginia, we examined payer composition between 2016 and 2023 and analyzed 2023 demographic and clinical data for adults ages 19-64. Results: Medicaid's share of ICU stays more than doubled from 2016 (14.1%) to 2023 (31.8%). While only 25.6% of Medicaid hospitalizations involved ICU care, these stays account disproportionately for charges (51.7%), hospital days (36.9%), and readmissions (32.3%). Common reasons for admission include potentially preventable conditions: sepsis, diabetes, heart failure, and alcohol use. Medicaid patients, despite being younger than their commercially insured counterparts, have more comorbidities (4+ comorbidities: 49.9% vs 38.9%) and are more likely to be readmitted in adjusted models (29.7% [95% Confidence Interval: 29.1-30.4] vs 24.3% [95% Confidence Interval: 23.6%-25.1%]). Conclusions: This work demonstrates the crucial role of Medicaid as a payer for seriously ill adults and the need for increased attention by Medicaid programs to ICU patients before, during, and after hospitalization.