{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T01:52:31Z","timestamp":1781833951502,"version":"3.54.5"},"reference-count":28,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","award":["IIR 19\u2010057"],"award-info":[{"award-number":["IIR 19\u2010057"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["shmpublications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Hospital Medicine"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The Affordable Care Act (ACA) allowed states to expand Medicaid to adults under 138 percent of the federal poverty line. Questions remain about how expansion influences health care utilization by Veterans already enrolled in the Veterans Health Administration (VHA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To understand changes in VHA share of inpatient utilization among VHA\u2010enrolled Veterans after Medicaid expansion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Sample included Veterans aged 18\u201364 from 2011 to 2016 enrolled in VHA. Outcomes included changes in VHA share of total VHA\u2009+\u2009Medicaid inpatient days, proportion with VHA and Medicaid inpatient dual use, total per\u2010capita inpatient days, and likelihood of any inpatient visits, moderated by VHA priority group and race. We controlled for sex, age, year, health status, ethnicity, and VHA distance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Population included 17,573,731 person years, 1,808,321 with inpatient days. Expansion was associated with relative decreases in VHA share of inpatient days (\u22122.60 percentage points [95% confidence interval \u22123.38 to \u22121.81]) and increases in proportion of VHA\u2010enrollees using both VA and Medicaid for inpatient care (1.17 pp [0.89 to 1.43]). While both per\u2010capita inpatient days and proportion of VHA enrollees with at least one hospitalization decreased from 2011 to 2016, no statistically significant differences existed between expansion and non\u2010expansion states. Low\u2010income Veterans had larger decreases in the VHA share of inpatient days (\u22126.27 pp [\u22127.32 to \u22125.21]) associated with Medicaid expansion. No racial groups exhibited statistically significant differences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Medicaid expansion is associated with reductions in VHA share and increase in dual use of VHA\u2010Medicaid inpatient services, but no changes in overall utilization.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jhm.70365","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T01:29:51Z","timestamp":1781832591000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Medicaid expansion and potential effects on Veterans Health Administration inpatient utilization"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2417-6057","authenticated-orcid":false,"given":"Patrick N.","family":"O'Mahen","sequence":"first","affiliation":[{"name":"US Department of Veterans' Affairs, Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center Veterans Health Administration Houston Texas USA"},{"name":"Section for Health Services Research, Department of Medicine Baylor College of Medicine Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chase S.","family":"Eck","sequence":"additional","affiliation":[{"name":"US Department of Veterans' Affairs, Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center Veterans Health Administration Houston Texas USA"},{"name":"Section for Health Services Research, Department of Medicine Baylor College of Medicine Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pui\u2010Yan","family":"Wong","sequence":"additional","affiliation":[{"name":"US Department of Veterans' Affairs, Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center Veterans Health Administration Houston Texas USA"},{"name":"Section for Health Services Research, Department of Medicine Baylor College of Medicine Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3757-4185","authenticated-orcid":false,"given":"Melissa K.","family":"Knox","sequence":"additional","affiliation":[{"name":"US Department of Veterans' Affairs, Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center Veterans Health Administration Houston Texas USA"},{"name":"Section for Health Services Research, Department of Medicine Baylor College of Medicine Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura A.","family":"Petersen","sequence":"additional","affiliation":[{"name":"US Department of Veterans' Affairs, Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center Veterans Health Administration Houston Texas USA"},{"name":"Section for Health Services Research, Department of Medicine Baylor College of Medicine Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,18]]},"reference":[{"key":"e_1_2_8_2_1","volume-title":"Building on the evidence base: Studies on the effects of Medicaid expansion, February 2020 to March 2021","author":"Guth M","year":"2021"},{"key":"e_1_2_8_3_1","volume-title":"The effects of Medicaid expansion under the ACA: Updated findings from a literature review","author":"Guth M","year":"2021"},{"key":"e_1_2_8_4_1","unstructured":"deGrootK O'MahenPN. Using Medicaid data in VA research. VA Information Resource Center;2024. 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