Medicare Advantage Linked to 29% Lower Kidney Transplant Rates After 2021 Eligibility Expansion

The Brown University-led analysis examined claims data after the 21st Century Cures Act expanded Medicare Advantage eligibility for kidney failure patients. Researchers adjusted for demographics, comorbidities, and geography but could not rule out residual confounding from unmeasured factors such as provider networks or referral patterns. Absolute transplantation rates remained low in both groups, underscoring broader organ shortage constraints.

Medicare Advantage plans often impose prior authorization and narrower specialist networks that may delay transplant evaluation, contrasting with traditional Medicare's broader provider access. Similar patterns appear in earlier studies of cardiac procedures and cancer care, where plan type influenced timely specialist referral. The 2021 policy change aimed to increase choice yet appears to have widened access gaps without corresponding quality safeguards.

Future monitoring should track whether CMS network adequacy rules or prior authorization reforms narrow these differences. A randomized or instrumental-variable study comparing plan types within the same health systems would better isolate causal effects from selection bias.

The study design shows association after adjustment but cannot establish causation; next research requires longitudinal follow-up of waitlist outcomes and plan-level process measures.