{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T11:26:59Z","timestamp":1789471619203,"version":"build-2803163510"},"reference-count":35,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2020,3,8]],"date-time":"2020-03-08T00:00:00Z","timestamp":1583625600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["K12HS023011"],"award-info":[{"award-number":["K12HS023011"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Sickle cell disease (SCD) is associated with high acute healthcare utilization. The purpose of this study was to examine whether Medicaid expansion in California increased Medicaid enrollment, increased hydroxyurea prescriptions filled, and decreased acute healthcare utilization in SCD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Individuals with SCD (\u226465 years and enrolled in Medicaid for \u22656 total calendar months any year between 2011 and 2016) were identified in a multisource database maintained by the California Sickle Cell Data Collection Program. We describe trends and changes in Medicaid enrollment, hydroxyurea prescriptions filled, and emergency department (ED) visits and hospital admissions before (2011\u20102013) and after (2014\u20102016) Medicaid expansion in California.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The cohort included 3635 individuals. Enrollment was highest in 2014 and lowest in 2016 with a 2.8% annual decease postexpansion. Although\u00a0&lt;20% of the cohort had a hydroxyurea prescription filled, the percentage increased by 5.2% annually after 2014. The ED visit rate was highest in 2014 and decreased slightly in 2016, decreasing by 1.1% annually postexpansion. Hospital admission rates were similar during the pre\u2010 and postexpansion periods. Young adults and adults had higher ED and hospital admission rates than children and adolescents.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Medicaid expansion does not appear to have improved enrollment or acute healthcare utilization among individuals with SCD in California. Future studies should explore whether individuals with SCD transitioned to other insurance plans or became uninsured postexpansion, the underlying reasons for low hydroxyurea utilization, and the lack of effect on hospital admissions despite a modest effect on ED visits.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.28152","type":"journal-article","created":{"date-parts":[[2020,3,9]],"date-time":"2020-03-09T06:21:51Z","timestamp":1583734911000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Impact of Medicaid expansion on access and healthcare among individuals with sickle cell disease"],"prefix":"10.1002","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4393-4949","authenticated-orcid":false,"given":"Mariam","family":"Kayle","sequence":"first","affiliation":[{"name":"Clinical Health Systems and Analytics Division Duke University School of Nursing  Durham North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jhaqueline","family":"Valle","sequence":"additional","affiliation":[{"name":"Sickle Cell Data Collection Program Tracking California\/Public Health Institute  Richmond California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Paulukonis","sequence":"additional","affiliation":[{"name":"Sickle Cell Data Collection Program Tracking California\/Public Health Institute  Richmond California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane L.","family":"Holl","sequence":"additional","affiliation":[{"name":"Biological Sciences Division University of Chicago  Chicago Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"Tanabe","sequence":"additional","affiliation":[{"name":"Clinical Health Systems and Analytics Division Duke University School of Nursing  Durham North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dustin D.","family":"French","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Feinberg School of Medicine Northwestern University  Chicago Illinois"},{"name":"Center for Health Services and Outcomes Research, Feinberg School of Medicine Northwestern University  Chicago Illinois"},{"name":"Veterans Affairs Health Services Research and Development Service  Chicago Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravi","family":"Garg","sequence":"additional","affiliation":[{"name":"Center for Health Services and Outcomes Research, Feinberg School of Medicine Northwestern University  Chicago Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2057-3749","authenticated-orcid":false,"given":"Robert I.","family":"Liem","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Northwestern University Feinberg School of Medicine  Chicago Illinois"},{"name":"Division of Hematology, Oncology and Stem Cell Transplant Ann &amp; Robert H. Lurie Children's Hospital of Chicago  Chicago Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherif M.","family":"Badawy","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Northwestern University Feinberg School of Medicine  Chicago Illinois"},{"name":"Division of Hematology, Oncology and Stem Cell Transplant Ann &amp; Robert H. Lurie Children's Hospital of Chicago  Chicago Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0521-1846","authenticated-orcid":false,"given":"Marsha J.","family":"Treadwell","sequence":"additional","affiliation":[{"name":"Department of Hematology\/Oncology University of California San Francisco Benioff Children's Hospital  Oakland Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,3,8]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2009.12.022"},{"key":"e_1_2_10_3_1","unstructured":"Centers for Disease Control and Prevention.Data & statistics on sickle cell disease.https:\/\/www.cdc.gov\/ncbddd\/sicklecell\/data.html. 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The effects of Medicaid expansion under the ACA: updated findings from a literature review (Issue Brief No. ###).2018.https:\/\/www.kff.org\/medicaid\/issue-brief\/the-effects-of-medicaid-expansion-under-the-aca-updated-findings-from-a-literature-review-march-2018\/."},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2016.303155"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.12834"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.12711"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.378"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.21515"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.14423\/SMJ.0000000000000526"},{"issue":"2014","key":"e_1_2_10_13_1","first-page":"1","article-title":"Increased service use following Medicaid expansion is mostly temporary: evidence from California's low income health program","author":"Lo N","year":"2014","journal-title":"Policy Brief UCLA Cent Health Policy Res"},{"key":"e_1_2_10_14_1","article-title":"Evidence\u2010based managment of sickle cell disease","author":"National Heart, Lung, and Blood Institute, Expert Panel","year":"2014","journal-title":"Expert Panel Report"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-148-12-200806170-00221"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.24587"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2008-0441"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prrv.2013.11.003"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/pds.4860"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.21883"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0199375"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12955-017-0713-x"},{"key":"e_1_2_10_23_1","volume-title":"The Medi\u2010Cal Program","author":"McConville S","year":"2017"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1177\/0033354919839072"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.29245\/2572-9411\/2017\/4.1124"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.26390"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.25208"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1541-0420.2006.00528.x"},{"key":"e_1_2_10_29_1","unstructured":"The California Health Care Landscape. 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