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Medicaid Expansion, Coverage Loss, and Disparities in Kidney Health in the COVID-19 Era

Award Number: R01DK113298
ORGANIZATION: NATIONAL INSTITUTE OF DIABETES & DIGESTIVE & KIDNEY DISEASES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 02/01/2017
PERIOD OF PERFORMANCE END DATE: 04/30/2025

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Medicaid Expansion, Coverage Loss, and Disparities in Kidney Health in the COVID-19 Era - Project Summary The burden of kidney failure, a life-threatening condition that afflicts nearly 750,000 Americans, falls disproportionately on the most socially disadvantaged communities in the US. Inadequate access to care and lack of health insurance coverage are critical drivers of racial/ethnic and socioeconomic disparities in the incidence of kidney failure and outcomes after initiating kidney replacement therapy. In our current grant (R01DK113298), we found that, among nonelderly patients initiating dialysis, Medicaid expansions under the Affordable Care Act (ACA) reduced uninsurance, increased the likelihood of starting long-term hemodialysis with maturing or functional arteriovenous access, and lowered one-year mortality. Compared with white patients, Black patients experienced a 3-fold greater absolute decline in mortality following expansion. Although there is a growing evidence base of the impact of Medicaid expansion on access to care and health, these prior studies have examined a period of sustained economic growth and declining rates of uninsurance. But the effects of expanded Medicaid coverage may be magnified during times of economic distress. During the first six weeks of the COVID-19 pandemic, an unprecedented forty million Americans have filed unemployment benefits, with expectations of stark coverage losses, particularly in nonexpansion states. Moreover, death rates from COVID-19 are higher in racial/ethnic minority populations and among patients with chronic conditions, including kidney disease. The pandemic has also disrupted care, with potential adverse consequences for populations with complex medical needs and social risk factors. National estimates of the impact of COVID-19 and expanded Medicaid coverage on access to care and outcomes are needed to inform effective public health responses. This R01 renewal application will examine disparities in coverage, access to care, transplant evaluation, and mortality among patients with kidney failure during and after the pandemic (Aim 1), as well as the protective role of Medicaid expansion on disparities in treatment and outcomes of kidney failure (Aim 2), and incidence (Aim 3). The rationale for our study is that the COVID-19 pandemic presents fundamental threats to access to care and health outcomes for persons with kidney disease, but expanded Medicaid coverage may attenuate these effects, reduce racial/ethnic and socioeconomic disparities, and therefore inform health policy. We innovate by geolocating address data for incident ESKD patients, thereby deriving granular information on neighborhood disadvantage, modeling incidence within small geographic areas, and identifying patients living in areas with high infection rates. Further, we consider the long-term effects of Medicaid expansion on disparities in transplantation and home dialysis, two alternatives to hemodialysis prioritized by the 2019 Advancing American Kidney Health Executive Order. We expect that this proposal can inform policy by providing timely and rigorous estimates of the effects of expanded Medicaid coverage on disparities in kidney health following the COVID-19 pandemic and its economic aftermath.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = -$51,642 )
2025	2023	BROWN UNIVERSITY	1 PROSPECT ST	PROVIDENCE	RI	02912	PROVIDENCE	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	7	9/11/2025	NON-COMPETING CONTINUATION	-$51,642
														Subtotal = -$51,642

Issue Date FY: 2023 ( Subtotal = $229,622 )
2023	2023	BROWN UNIVERSITY	1 PROSPECT ST	PROVIDENCE	RI	02912	PROVIDENCE	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	7	3/29/2023	NON-COMPETING CONTINUATION	$229,622
														Subtotal = $229,622

Issue Date FY: 2022 ( Subtotal = $229,494 )
2022	2022	BROWN UNIVERSITY	1 PROSPECT ST	PROVIDENCE	RI	02912	PROVIDENCE	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	6	4/8/2022	NON-COMPETING CONTINUATION	$229,494
														Subtotal = $229,494

Issue Date FY: 2021 ( Subtotal = $228,780 )
2021	2021	BROWN UNIVERSITY IN PROVIDENCE IN THE STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS	1 PROSPECT ST	PROVIDENCE	RI	02912	PROVIDENCE	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	5	7/8/2021	COMPETING CONTINUATION	$228,780
2021	2020	BROWN UNIVERSITY	1 PROSPECT ST	PROVIDENCE	RI	02912	PROVIDENCE	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	001	4	9/25/2021	NON-COMPETING CONTINUATION	$0
														Subtotal = $228,780

Issue Date FY: 2020 ( Subtotal = $380,041 )
2020	2020	BROWN UNIVERSITY IN PROVIDENCE IN THE STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS	1 PROSPECT ST	PROVIDENCE	RI	02912	PROVIDENCE	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	4	2/26/2020	NON-COMPETING CONTINUATION	$380,041
														Subtotal = $380,041

Issue Date FY: 2019 ( Subtotal = $389,253 )
2019	2019	BROWN UNIVERSITY IN PROVIDENCE IN THE STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS	1 PROSPECT ST	PROVIDENCE	RI	02912	PROVIDENCE	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	3	1/10/2019	NON-COMPETING CONTINUATION	$389,253
														Subtotal = $389,253

Issue Date FY: 2018 ( Subtotal = $402,104 )
2018	2018	BROWN UNIVERSITY IN PROVIDENCE IN THE STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS	1 PROSPECT ST	PROVIDENCE	RI	02912	PROVIDENCE	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	001	2	4/20/2018	NON-COMPETING CONTINUATION	$40,210
2018	2018	BROWN UNIVERSITY IN PROVIDENCE IN THE STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS	1 PROSPECT ST	PROVIDENCE	RI	02912	PROVIDENCE	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	2	12/21/2017	NON-COMPETING CONTINUATION	$361,894
														Subtotal = $402,104

Issue Date FY: 2017 ( Subtotal = $384,764 )
2017	2017	BROWN UNIVERSITY IN PROVIDENCE IN THE STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS	1 PROSPECT ST	PROVIDENCE	RI	02912	PROVIDENCE	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	1	1/24/2017	NEW	$384,764
														Subtotal = $384,764

Grand Total All Awards = $2,192,416

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Medicaid Expansion, Coverage Loss, and Disparities in Kidney Health in the COVID-19 Era

Award Number: R01DK113298

ORGANIZATION: NATIONAL INSTITUTE OF DIABETES & DIGESTIVE & KIDNEY DISEASES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 02/01/2017

PERIOD OF PERFORMANCE END DATE: 04/30/2025

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