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Coverage and Access Changes During Medicaid Unwinding.

Adrianna McIntyre¹, Benjamin D Sommers^1,2, Gabriella Aboulafia¹

¹Harvard University T.H. Chan School of Public Health, Department of Health Policy and Management, Boston, Massachusetts.

JAMA Health Forum

|June 29, 2024

Summary

One in eight adults lost Medicaid coverage during the unwinding of pandemic-era continuous coverage. Losing Medicaid led to increased insurance gaps and challenges accessing care, particularly due to cost.

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Area of Science:

Health Services Research
Public Health Policy
Health Equity

Background:

States resumed Medicaid eligibility redeterminations in 2023 after a pause during the COVID-19 public health emergency.
The unwinding of continuous Medicaid coverage raised concerns about potential loss of coverage and its impact on access to care for low-income populations.

Purpose of the Study:

To assess early changes in insurance status and access to care among low-income individuals in four Southern states during the Medicaid unwinding period.
To identify factors associated with Medicaid loss and compare care access and affordability between those who lost coverage and those who remained enrolled.

Main Methods:

A multimodal survey was conducted in Arkansas, Kentucky, Louisiana, and Texas from September to November 2023.
The survey included US citizens aged 19-64 with incomes at or below 138% of the federal poverty level, using random-digit dialing and address-based sampling.
Multivariate logistic regression was used to evaluate factors associated with Medicaid loss and compare access to care.

Main Results:

Among adult respondents who had Medicaid, 12.5% were no longer enrolled at the time of the survey, with significant state variation.
Nearly half (47.8%) of adults who lost Medicaid coverage became uninsured, while others obtained different forms of insurance, often with gaps.
Losing Medicaid was associated with increased delays in seeking care due to cost and greater difficulty affording care.

Conclusions:

Six months into the Medicaid unwinding process, a notable proportion of beneficiaries lost coverage, highlighting state-level disparities.
A significant number of individuals who lost Medicaid became uninsured or experienced coverage gaps, impacting their ability to access necessary healthcare.
The study underscores the critical link between Medicaid coverage and access to affordable care, particularly for vulnerable, low-income populations.