A survey of low-income adults in Arkansas, Kentucky, Louisiana and Texas from the Harvard T.H. Chan School of Public Health found that one in eight respondents who had Medicaid coverage at some point since March 2020 reported they would lose their Medicaid coverage by the second half of 2023, and nearly half of those were currently uninsured.
The researchers conducted the study from September to November 2023, about six months after the start of “Medicaid de-escalation,” the process by which states revalidate Medicaid enrollees' eligibility after COVID-19-era insurance protections expire.
“Of the more than 90 million people whose health insurance was put at risk by the repeal of Medicaid, government statistics show that more than 23 million were dropped from the program. But these statistics don't tell us what happened to these people or why they lost their insurance. Our study is one of the first to answer these outstanding questions using entirely new data from an independently conducted, multistate survey.”
Adriana McIntyre, assistant professor of health policy and political science, lead author
The study will be published in JAMA Health Forum on June 29th.
Researchers surveyed 2,210 adults ages 19 to 64 in four states with incomes at or below 138% of the federal poverty line in 2022. Participants were asked whether they or their dependents had been enrolled in Medicaid since their state suspended Medicaid withdrawals as part of the COVID-19 federal public health emergency in March 2020. They also were asked about their current health insurance, their ability to obtain health care, and demographic information.
The majority of survey respondents (71%) reported that they or their dependents had been enrolled in Medicaid at some point since March 2020. Among adult respondents who had Medicaid, 12.5% ​​reported disenrollment by fall 2023. Adult disenrollment rates by state varied, ranging from 16% in Arkansas to 15% in Texas, 8% in Louisiana, and 7% in Kentucky. While 52% of disenrollees found alternative insurance, a significant proportion of respondents reported experiencing a gap in coverage. The remaining 48% of disenrollees reported being uninsured. Disenrollment was significantly higher among younger adults, rural residents, and employed individuals, and women were more likely to be uninsured than men. Reported disenrollment rates were significantly lower on average for dependent children (5.4%).
The survey also found that disenrolled people had significantly worse access to health care compared to people who did not lose Medicaid coverage: disenrolled people were more likely to report cost-related delays in care (51% vs. 27%) and delays or skipped medications (45% vs. 27%), say care was less affordable than in the previous year (47% vs. 22%), and miss annual checkups in the previous year (57% vs. 34%).
“Prior research has shown that even short gaps in coverage can lead to interruptions in care and poorer health outcomes,” McIntyre said. “Our findings suggest that state and federal policymakers should pursue policies that mitigate the adverse effects of coverage interruptions not only during the Medicaid wind-down period but also in the years to come, because issues regarding eligibility redeterminations and coverage continuity will continue to be important issues in Medicaid.”
The researchers noted that the generalizability of their findings may be limited for several reasons, including that the study sample was limited to residents of four states who reported low income and there was considerable variation in states' approaches to lifting restrictions.
Co-authors are Benjamin Sommers, Gabriela Aboulafia, Jessica Phelan, E. John Olaf, Arnold Epstein and Jose Figueroa from the Harvard Chan School of Health Policy and Management.
The study was funded by the Commonwealth Fund and the Episcopal Health Foundation.
sauce:
Harvard T.H. Chan School of Public Health
Journal References:
McIntyre, A., et al. (2024). Changes in Coverage and Access with Medicaid Repeal. JAMA Health Forum. doi.org/10.1001/jamahealthforum.2024.2193.
