Racial Disparities and Personal Responsibility Incentives in Medicaid

Area of Science:

• Health Services Research
• Health Equity
• Public Health Policy

Background:

• Medicaid personal responsibility incentives may create disparities in healthcare access.
• Understanding racial differences in enrollment and benefit comprehensiveness is crucial for health equity.

Purpose of the Study:

• To examine how personal responsibility incentives in Medicaid affect enrollment and benefit comprehensiveness for non-Hispanic Black and non-White members.
• To assess the impact of suspending these incentives during the COVID-19 Public Health Emergency (PHE) on racial disparities.

Main Methods:

• An interrupted time series analysis was used to evaluate trends in racial disparity ratios.
• Data from 939,667 non-Hispanic Black and non-Hispanic White adults enrolled in Healthy Indiana Plans (HIP) from 2018-2023 were analyzed.

Main Results:

• Before the PHE, non-Hispanic Black members were 23% less likely to be in the more comprehensive HIP Plus plan compared to non-Hispanic White members.
• Suspension of incentives during the PHE reduced this disparity, moving towards parity.
• An administrative upgrade to HIP Plus plans further increased parity, reaching 0.994.

Conclusions:

• Medicaid personal responsibility incentives are linked to significant and lasting racial disparities in enrollment and plan comprehensiveness.
• Temporary removal of incentives can decrease disparities, but sustained equitable access requires proactive policy interventions.