Changes in Medication Use During Medicaid Continuous Enrollment and Unwinding

Area of Science:

• Health Services Research
• Public Health Policy
• Pharmaceutical Economics

Background:

• Medicaid enrollment surged during the COVID-19 pandemic due to suspended eligibility reviews.
• The end of continuous enrollment in April 2023 led to millions losing Medicaid coverage.
• Understanding the impact of this "unwinding" on healthcare access is crucial.

Purpose of the Study:

• To assess the association between Medicaid enrollment changes and patient prescription medication use.
• To analyze the effects of the Medicaid continuous enrollment provision and its subsequent unwinding on healthcare service utilization.

Main Methods:

• Cross-sectional study utilizing interrupted time series analysis.
• Compared quarterly Medicaid enrollment and prescription data from Q1 2018 to Q1 2024.
• Analyzed medication use for chronic conditions and pediatric formulations, stratified by state policies.

Main Results:

• Medicaid enrollment peaked in Q2 2023, followed by a quarterly decrease during unwinding.
• Prescription medication use mirrored enrollment trends, showing quarterly decreases post-unwinding.
• States with higher disenrollment saw greater reductions in chronic disease medication use; protective policies lessened these impacts.

Conclusions:

• Medicaid unwinding measurably affected patient access to prescription medications.
• While enrollment changes were larger than medication use changes, the impact on access was significant.
• State-level policies played a role in mitigating negative effects on medication access during the unwinding period.