Related Experiment Video
Updated: Jan 1, 2026
Observing and Quantifying Fibroblast-mediated Fibrin Gel Compaction
Published on: January 16, 2014
Purged from the Rolls: A Study of Medicaid Disenrollment in Iowa
Natoshia M Askelson1,2, Patrick Brady1,2, Brad Wright3
1Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, Iowa.
Abstract:
Purpose: To describe the impact of disenrollment from Medicaid because of failure to pay premiums as part of Iowa's Medicaid program's personal responsibility component. Methods: We conducted a mixed method study consisting of in-depth interviews with disenrolled members in 2016 and 2017 (n=72) and a survey of disenrolled members in 2017 (n=225). Results: Many disenrollees did not know why they were disenrolled, were unaware of the personal responsibility component or premium requirement, and were confused by the disenrollment process. Disenrollment had negative effects including stress, financial burden, and engaging in behaviors such as skipping medication and postponing medical or dental care. Furthermore, disenrollees were often unable to enroll in health insurance, and for those who did, many reported it was a difficult process. Conclusions: Disenrollment had numerous, negative impacts on members who failed to pay their premiums. There was confusion about program requirements, which might indicate challenges communicating about a complicated program. Policymakers need to consider how to design and implement personal responsibility programs to achieve their desired outcome and reduce confusion and negative consequences.
Insights
Many Medicaid members lost coverage due to unpaid premiums, facing confusion and negative health impacts. Improved communication and program design are needed to reduce these consequences.
Area of Science:
- Health Services Research
- Public Health Policy
Background:
- Iowa's Medicaid program implemented a personal responsibility component requiring premium payments.
- Failure to pay premiums can lead to disenrollment from Medicaid coverage.
Purpose of the Study:
- To examine the effects of Medicaid disenrollment resulting from unpaid premiums in Iowa.
- To understand member experiences with the personal responsibility component and disenrollment process.
Main Methods:
- Mixed-methods study combining in-depth interviews (n=72) and surveys (n=225) with disenrolled Medicaid members.
- Data collected from individuals disenrolled in 2016 and 2017.
Main Results:
- Many disenrollees were unaware of premium requirements and the reasons for their disenrollment.
- Negative impacts included increased stress, financial strain, medication non-adherence, and delayed medical/dental care.
- Enrolling in alternative health insurance post-disenrollment was challenging for many.
Conclusions:
- Medicaid disenrollment due to non-payment of premiums has significant adverse effects on members.
- Confusion surrounding program rules suggests communication challenges in complex public health programs.
- Policymakers should refine personal responsibility program design to minimize confusion and negative outcomes.
Related Concept Videos
01:29Documentation in Long-Term and Home Healthcare Setting
Long-Term Care Facilities
01:22Standards of Care I
01:21Methods of Documentation III: PIE
01:09Censoring Survival Data
01:29Issues And Trends In Healthcare Delivery System
Cost Containment
Payment for healthcare services has historically promoted adoption of costly and often unnecessary or inefficient...
01:29Data Collection II