Evaluating Emergency Medicaid Program Policy Changes During the COVID-19 Pandemic

Area of Science:

• Health Services Research
• Public Health Policy
• Trauma Care

Background:

• Uninsured trauma patients face barriers to care and higher mortality.
• Hospital Presumptive Eligibility (HPE) provides emergency Medicaid to eligible patients.
• The COVID-19 pandemic prompted significant changes to the HPE program.

Purpose of the Study:

• To evaluate the success of the HPE program during the COVID-19 pandemic.
• To identify factors associated with HPE approval.
• To assess the impact of policy changes on insurance access for trauma patients.

Main Methods:

• A mixed-methods approach combining retrospective cohort analysis (2015-2021) and semistructured interviews.
• Analysis of HPE approval rates before and after COVID-19 policy implementation.
• Qualitative interviews with key stakeholders to understand program adaptations.

Main Results:

• HPE approval rates significantly improved during the COVID-19 pandemic (61% vs. 48% prepandemic).
• The pandemic period was associated with a 1.64-fold increased likelihood of HPE approval.
• Interviews indicated state-based eligibility expansion and remote approval methods contributed to success.

Conclusions:

• The HPE program demonstrated increased effectiveness and adaptability during the COVID-19 pandemic.
• Policy adaptations enhanced insurance access for trauma patients.
• Sustaining these improvements is crucial for ongoing patient care and health equity.