干预措施自动化医疗补助更新减少程序拒绝并增加覆盖范围
Pamela Herd1, Eric R Giannella2, Jeremy Barofsky3
1Pamela Herd, University of Michigan, Ann Arbor, Michigan.
Health affairs (Project Hope)
|November 3, 2025
概括
自动化医疗补助计划的续期减少了符合条件的个人的保险损失. 这项研究表明,当各州有实施能力时,ex parte续约显著提高了入学率,并减少了程序性拒绝.
科学领域:
- 卫生政策 卫生政策
- 公共卫生 公共卫生
- 医疗保健服务研究 医疗服务研究
背景情况:
- 医疗补助计划的续期流程可能是繁的,导致符合条件的个人失去保险.
- 随着COVID-19公共卫生紧急情况的持续招生条款的结束,导致超过9000万受益人的重新确定.
- 许多最初的退学是由于程序性原因发生的,例如不完整的文书工作.
研究的目的:
- 检查增加自动化医疗补助计划 (Medicaid) 的部分续期延期对覆盖率损失的影响.
- 评估一项联邦倡议的有效性,该倡议与四个州合作,以加强一方续约.
- 减少程序性拒绝,并为符合条件的受益人保持医疗补助覆盖.
主要方法:
- 分析来自四个参与州的州级医疗补助入学数据,并与其他州进行比较.
- 审查了ex parte续约率,整体续约率和程序性拒绝率的变化.
- 专注于COVID-19公共卫生紧急情况持续招生条款结束后的时期.
主要成果:
- 与其他国家相比,在四个重点国家,ex parte续约增加了21.6个百分点.
- 在这些州,医疗补助计划的整体续期增加了7.7个百分点.
- 在增加自律续约的州,程序性拒绝减少了8.3个百分点.
结论:
- 自动化医疗补助计划的续期有效降低了负担,并防止符合条件的受益人失去保险.
- 成功实施减少程序性拒绝政策取决于国家能力.
- 通过自动化简化续约流程对于维持医疗保险获得权至关重要.
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