Statement of Purpose A substantial proportion of adolescents in the US who are hospitalized for firearm injury and survive require subsequent hospitalizations, but lack health insurance. However, they become eligible for Medicaid through a post-injury enrollment policy. The impact of Medicaid conversions in this population has not been evaluated. We determined the difference in the likelihood of hospital readmissions among adolescents surviving firearm injury hospitalization by health insurance, and whether this likelihood changed after postinjury Medicaid conversion.

Methods/Approach We conducted a retrospective cohort study using data from the National Readmissions Database (2011–2014). We used Cox proportional hazards regression to assess the association of insurance status (Medicaid, private insurance, or uninsured) with time to readmission within 180 days of discharge, among adolescents (10–19 years of age) discharged alive after treatment of a firearm injury.

Results We compared 6,840 Medicaid-insured patients to 2,969 privately-insured patients and 2,664 uninsured patients in a cohort of adolescents hospitalized due to firearm injury. There was no difference in the likelihood of readmission within 180-days after discharge among the three groups, considering insurance designation at the time of the injury. Based on postinjury payer conversion, the likelihood of readmissions did not vary between the Medicaid and private insurance groups, while the likelihood was 75% greater in the Medicaid group versus uninsured group (adjusted hazard ratio=1.75, 95% CI 1.24, 2.48).

Conclusion Medicaid bears the financial burden of treatment for firearm injuries, providing subsequent treatment to adolescents after firearm injury.

Significance Adolescents surviving a firearm injury are discharged from the hospital to adverse environmental stressors with disability and face competing decisions to spend on health versus paying utilities, rent, etc. to survive. Conversion to Medicaid in this vulnerable group of adolescents may allow them to obtain treatment so that they can recover.