D129. The Effect of Medicaid Expansion on Rates of Carpal Tunnel Release: An Interrupted Time Series Analysis

PURPOSE: Medicaid expansion through the Affordable Care Act (ACA) has been associated with greater access and utilization of surgical services in underserved populations. However, its impact on hand surgery is less understood. The purpose of this study was to evaluate the association between rates of carpal tunnel release (CTR) in Medicaid beneficiaries and New York State adoption of the ACA. METHODS: We conducted a pooled cross-sectional analysis of patients who underwent CTR using the Healthcare Cost and Utilization Project New York State all-payer database (2010-2018). An interrupted time series (ITS) analysis using an autoregressive integrated moving average model estimated the immediate and long-term impact of Medicaid expansion in January 2014 on CTR procedural volume in Medicaid beneficiaries and uninsured individuals. RESULTS: A total of 112,569 were included in the sample. After expansion, we observed an absolute increase of 6%, from 13% to 19%, in the share of CTR procedures provided to Medicaid beneficiaries. Policy implementation was associated with an immediate 1.8% increase (95% CI=0.008, 0.028; p<0.001) in the probability of Medicaid as the primary payer and an annual increase of 1.2% (95% CI=0.012, 0.024; p<0.001) after reform. ITS analysis found this resulted in an additional 4,190 CTR procedures provided to Medicaid beneficiaries. CONCLUSION: Study results suggest New York's adoption of the ACA was associated with an immediate and steady increase in outpatient CTR among Medicaid beneficiaries. Most of this increase represented newly treated patients rather than those who were previously uninsured.