Year of Publication



Public Health

Date Available


Degree Name

Master of Public Health (M.P.H.)

Committee Chair

John Lyons


Inflammatory bowel disease (IBD) affects over 3 million adults in America, relaying a

need for chronic disease management. Along with 24 other states, Kentucky expanded the

Medicaid program January 1, 2014. We hypothesize, Medicaid expansion adoption results in

reduced emergency healthcare services, and increased elective healthcare services with a

reduction in overall healthcare utilization by individuals in the adult IBD population.

The Hospital Inpatient Discharge and Outpatient Services Database identify encounters

related to ulcerative colitis or Crohn’s disease from 2009-2020, in Kentucky. Patient

demographics, admission type, discharge, length of stay, and hospital charges were compared.

3386 pre-expansion and 24255 post expansion encounters for patients with IBD were

collected for analysis. Pre-expansion 47.4% of patients were electively admitted, compared to

76.0% following (p=0.001). Emergency visits decreased from 36.7% pre to 11.4% post

expansion (p=0.001). Admission following a clinical referral increased from 75.0% to 90.4%

post expansion with a corresponding drop in emergency room admission from 13.1% to 0.4%

(p=0.001). Median hospital costs and length of stay both had significant reduction following

Medicaid expansion.

In the IBD population, Medicaid expansion reduced overall healthcare utilization by

reducing emergency care and increasing usage of elective care pathways.

Available for download on Wednesday, April 23, 2025