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Key Points Question Did quality of care improve in safety-net hospitals after Medicaid expansion following passage of the Affordable Care Act? Findings This difference-in-differences analysis in a cohort study of 811 safety-net hospitals in Medicaid expansion vs nonexpansion states found little evidence for improvement in hospital quality in the domains of patient-reported experience, health care–associated infections, readmissions, or mortality in states that expanded Medicaid compared with those in states that did not. There were modest differential increases in the adoption of electronic health records between 2012 and 2016, and in the number of inpatient psychiatric beds between 2012 and 2018. Meaning The results of this study suggest that safety-net hospitals may require ongoing support for quality improvement in the post-Medicaid expansion era.
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