High obstructive sleep apnea severity and lack of treatment access in MassHealth Limited patients, a predominantly Latinx population

Abstract

Objectives: MassHealth Limited (MHL), a subset of Massachusetts' Medicaid program, covers sleep studies but not obstructive sleep apnea (OSA) treatment, including positive airway pressure (PAP) therapy. This study characterizes the demographics and OSA severity of patients receiving MHL and compares them to those with full MassHealth (MH) benefits to assess inequities in treatment access.

Participants and methods: We conducted a retrospective cohort study of 134 MHL and 402 MH patients who underwent a sleep study for OSA evaluation at the Brigham and Women's Faulkner Hospital (2019-2024). We analyzed age, BMI, OSA severity, SpO₂ % nadir, and comorbidity burden across four patient groups based on insurance and self-reported ethnicity: MHL-Latinx, MH-Latinx, MH-Black, and MH-White, with men and women assessed separately.

Results: The MHL population was predominantly Latinx (90 %), with 82 % preferring Spanish, Haitian Creole, or Brazilian Portuguese as their primary language. Moderate-to-severe OSA was most prevalent in MHL-Latinx men (77.5 %) and MHL-Latinx women (53.0 %). On follow-up, about one-third of MHL-Latinx patients with moderate-to-severe OSA obtained PAP therapy through self-pay or insurance change.

Conclusions: In this sample of MHL beneficiaries, a predominantly Latinx population, patients experience a high burden of moderate-to-severe OSA yet lack access to PAP therapy due to insurance limitations. Expanding MHL coverage to include OSA treatment is critical to addressing sleep health inequities.