Changes in Chronic Medication Dispensing to Children and Young Adults During Medicaid Unwinding

Medicaid eligibility determinations paused during the COVID-19 pandemic but resumed in April 2023. We evaluated whether this "Medicaid unwinding" disrupted chronic medication therapy in young patients.

This study was a difference-in-differences analysis of the 2017-2023 IQVIA Longitudinal Prescription Database (92% of US pharmacies). Analyses included Medicaid-insured children aged 0 to 18 years and young adults aged 19 to 25 years using 5 chronic medication classes during quarter 1 of 2017 to 2023: attention-deficit/hyperactivity disorder medications, antidepressants, antiepileptics, antipsychotics, and inhaled steroids. Outcomes included the number of days with active prescriptions, having no prescriptions, and having 1 or more cash-pay prescriptions in quarters 3 and 4 of 2017 to 2023. Changes between 2017 to 2022 and 2023 were compared among states in the top vs bottom quartile of the percent reduction in Medicaid enrollment through December 2023. Analyses were conducted separately by age group and medication class.

Sample sizes ranged between 226 311 and 4 683 451 person-years. Among children, residence in a state experiencing high Medicaid enrollment loss was associated with a greater decrease in the number of days with active prescriptions for 1 class and a greater increase in the risk of having 1 or more cash-pay prescriptions for 3 classes. Among young adults, residence in such a state was associated with a greater decrease in the number of days with active prescriptions for 2 classes and with a greater increase in the risk of having no prescriptions and 1 or more cash-pay prescriptions for all classes.

Medicaid unwinding disrupted chronic medication therapy in young patients, particularly young adults. To reverse these disruptions, policymakers could help disenrolled patients find alternative coverage.