Study reveals coverage gaps and health access challenges after Medicaid rollout

In a survey of low-income adults in Arkansas, Kentucky, Louisiana, and Texas, one in eight respondents who were enrolled in Medicaid at some point since March 2020 reported no longer having Medicaid coverage by the end of 2023, with nearly half of that group report being currently uninsured, according to a study by the Harvard TH Chan School of Public Health.

The researchers conducted the survey from September to November 2023, about six months after the start of “Medicaid unwinding” — the process by which states reassessed the eligibility of Medicaid enrollees after the end of COVID-era coverage protections. 19.

We know from government statistics that, of the more than 90 million people whose health coverage was at risk amid the Medicaid rollback, more than 23 million were removed from the program. But these statistics don’t tell us what happened to these people or why they lost coverage. Our study is among the first to help answer these outstanding questions, using entirely new data from an original multi-state survey.”

Adrianna McIntyre, Assistant Professor of Politics and Health Policy, main author

The study will be published on June 29 JAMA Health Forum.

The researchers looked at 2,210 adults ages 19 to 64 in those four states whose 2022 income was below 138 percent of the federal poverty line. Participants were asked if they and/or their dependents had enrolled in Medicaid at any point since March 2020, when states suspended Medicaid disenrollment as part of the federal COVID-19 public health emergency. They were also asked about their current health insurance and ability to access care, as well as their demographic information.

Most survey respondents (71%) reported that they and/or dependents had enrolled in Medicaid sometime since March 2020. Among adult respondents who had Medicaid, 12.5% ​​reported being enrolled by fall 2023 .State-specific Adult unenrollment rates varied: 16% in Arkansas, 15% in Texas, 8% in Louisiana, and 7% in Kentucky. Of those surveyed, 52% had found another source of insurance, although a significant percentage of those respondents reported experiencing coverage gaps. The remaining 48% of those surveyed reported being uninsured. Disenrollment was significantly higher among those who were younger, rural, and/or employed, and women were more likely than men to become uninsured. The reported dropout rate was much lower, on average, for dependent children (5.4%).

The study also found that those who had been enrolled had significantly worse access to health care compared to those who did not lose Medicaid coverage. Enrollees reported more cost-related delays in care (51% vs. 27%) and delays or missed medication doses (45% vs. 27%). said care was less affordable than last year (47% vs. 22%). and did not go for an annual checkup during the previous year (57% vs. 34%).

“In previous research, even short coverage gaps have been associated with disruptions in care and negative health outcomes,” said McIntyre. “Our findings suggest that state and federal policymakers should pursue policies to mitigate the negative outcomes associated with coverage interruptions—not only during Medicaid relaxation, but in the years to come as issues related to redetermination of eligibility and continuation of coverage will remain Medicaid related.”

The researchers noted that the study’s findings may be limited in their generalizability for several reasons, including that the study sample was limited to residents of four states that reported lower incomes and that there was considerable variation in states’ approaches to relaxation.

Benjamin Sommers, Gabriella Aboulafia, Jessica Phelan, E. John Orav, Arnold Epstein, and Jose Figueroa, all from the Harvard Chan Department of Health Policy and Management, were co-authors.

The study received funding from the Commonwealth Fund and the Episcopal Health Foundation.