Associations between a New York City Paid Sick Leave Mandate and Health Care Utilization among Medicaid Beneficiaries in New York City and New York State

Importance: More evidence on associations between mandated paid sick leave and health service utilization among low-income adults is needed to guide health policy and legislation nationwide. Objective: To evaluate the association between New York City's 2014 paid sick leave mandate and health care utilization among Medicaid-enrolled adults. Design, Setting, and Participants: This retrospective cohort study used New York State Medicaid administrative data for adults 18 to 64 years old continuously enrolled in Medicaid from August 1, 2011, through July 31, 2017. A difference-in-differences approach with entropy balancing weights was used to compare New York City with the rest of New York State to assess the association of the paid sick leave mandate with health care utilization, and for those 40 to 64 years old, with preventive care utilization. The data analysis was performed from June through August 2020. Exposures: Temporal and spatial variation in exposure to the mandate. Main Outcomes and Measures: Annual health care utilization (emergency care, specialist visits, and primary care clinician visits) per Medicaid-enrolled adult. Secondary outcomes include categories of emergency utilization and utilization of 5 preventive services. Results: Of 552857 individuals (mean [SD] age, 43 [12] years; 351130 [64%] women) who met inclusion criteria, 99181 (18%) were White, 162492 (29%) Black, and 138061 (25%) Hispanic. Paid sick leave was significantly associated with a reduction in the probability of emergency care (-0.6 percentage points [pp]; 95% CI, -0.7 to -0.5 pp; P <.001), including a 0.3 pp reduction (95% CI, -0.4 to -0.2; P <.001) in care for conditions treatable in a primary care setting and an increase in annual outpatient visits (0.124 pp; 95% CI, 0.040 to 0.208 pp; P <.001). Among those 40 to 64 years old, the mandate was significantly associated with increased probabilities of glycated hemoglobin A_1clevel testing (2.9 pp; 95% CI, 2.5-3.3 pp; P <.001), blood cholesterol testing (2.7 pp; 95% CI, 2.5-2.9 pp; P <.001), and colon cancer screening (0.4 pp; 95% CI, 0.2-0.6 pp; P <.001). Conclusions and Relevance: This retrospective cohort study of nonelderly adults enrolled in Medicaid New York State showed that mandated paid sick leave in New York City was significantly associated with differences in several dimensions of health care services use.