Medicaid Disenrollment Among Young Adults With and Without Complex Medical Conditions

Area of Science:

• Health Services Research
• Public Health
• Pediatric Health

Background:

• Loss of Medicaid coverage is a significant risk for young adults transitioning from child to adult healthcare systems.
• Individuals with complex medical conditions (CMCs) face heightened risks of morbidity and mortality upon losing health insurance.

Purpose of the Study:

• To quantify the risk of Medicaid disenrollment among young adults with and without CMCs.
• To examine variations in disenrollment risk based on medical condition and state of residence.

Main Methods:

• Retrospective observational study using 2016-2019 Medicaid administrative claims data from 47 states.
• Identified CMCs using the Pediatric Medical Complexity Algorithm.
• Employed discrete-time survival models and Kaplan-Meier curves to estimate disenrollment and reenrollment risks from ages 16-26.

Main Results:

• Disenrollment peaked at age 19, with conditional probabilities of 13.4% for individuals with CMCs and 35.6% for those without.
• Significant state-level variations in disenrollment risk were observed, ranging widely for both groups.
• Mental health and cardiac conditions showed the highest disenrollment probability among CMCs; factors like income eligibility and Medicaid expansion status influenced risk.

Conclusions:

• Disruptions in Medicaid coverage are prevalent for emerging adults, impacting those with and without CMCs.
• Coverage loss varies substantially by state and specific medical conditions.
• Understanding these patterns is crucial for developing targeted interventions to ensure continuous health insurance for vulnerable young adults.