The Association Between Human Papillomavirus Vaccination and State Medicaid Expansion

Purpose: The human papillomavirus (HPV) vaccine is recommended for US adolescents 11-12 years of age. The HPV vaccine is currently covered for children enrolled in Medicaid through age 20. After the passage the Affordable Care Act in 2010, states were given the option to expand Medicaid eligibility to 138% of the federal poverty level, yet as of December 2017, only 36 states have elected to expand their Medicaid program. This study examines the association between Medicaid expansion and HPV vaccination among US adolescents. Methods: This cross-sectional study was conducted using data from the National Immunization Survey – Teen, 2017 (N=20,949). Logistic regression was used to model provider-reported HPV vaccination up-to-date status predicted by state Medicaid expansion while adjusting for the effects of sex, race/ethnicity, maternal education level, household income, and type of health insurance. All analyses were conducted using SAS Studio 3.7 Enterprise Edition with survey weighting procedures. Results: 52% of adolescents in this study were up-to-date on the HPV vaccine. Adolescents who lived in states that expanded Medicaid [OR = 1.51, (95% CI: 1.36, 1.68)] were more likely to be up-to-date on the HPV vaccine than adolescents who lived in states that did not expand Medicaid. Females [OR = 1.50, (95% CI: 1.35, 1.66)], Non-Hispanic Blacks [OR = 1.23, [95% CI: 1.09, 1.54)], and Hispanics [OR = 1.67, (95% CI: 1.42, 1.96)] were more likely than to be up-to-date on the HPV vaccine than males and Non-Hispanic Whites, respectively. Individuals who were enrolled in Medicaid [OR = 1.19, (95% CI: 1.02, 1.39)] were more likely to be up-to-date than those with private insurance. Conclusion: The results of this study indicate a positive association between Medicaid expansion and HPV vaccination. However, Medicaid expansion is only one of many health policy initiatives that can affect HPV vaccination. Recent research has suggested that state-level policies (e.g., school-entry requirements, policies permitting vaccination in pharmacies, classroom sex education policies, and parental education mandates) are significantly associated with uptake of the HPV vaccine in adolescents. Further research should be conducted to analyze the combinatorial effects of multiple health policies on HPV vaccination.