Association of State Medicaid Expansion With Hospital Community Benefit Spending

Key Points Question Was Medicaid expansion associated with a change in nonprofit hospital spending on community benefits? Findings In this cohort study of 1666 nonprofit hospitals using a difference-in-differences analysis, Medicaid expansion was associated with a 0.68-percentage point decline in spending on charity care and a 0.17-percentage point decline in bad debt. These declines in uncompensated care were offset by an increase of 0.85 percentage points in unreimbursed Medicaid-related spending, while noncare direct community spending decreased by 0.24 percentage points. Meaning The results of this study suggest that although Medicaid expansion alleviated the financial stresses faced by hospitals in providing uncompensated care, these savings did not translate into additional direct community spending.