Changes in Medicaid enrollment during the COVID-19 pandemic across 6 states

Abstract

The coronavirus disease 2019 public health emergency (PHE) caused extensive job loss and loss of employer-sponsored insurance. State Medicaid programs experienced a related increase in enrollment during the PHE. However, the composition of enrollment and enrollee changes during the pandemic is unknown. This study examined changes in Medicaid enrollment and population characteristics during the PHE. A retrospective study documenting changes in Medicaid new enrollment and disenrollment, and enrollee characteristics between March and October 2020 compared to the same time in 2019 using full-state Medicaid populations from 6 states of a wide geographical region. The primary outcomes were Medicaid enrollment and disenrollment during the PHE. New enrollment included persons enrolled in Medicaid between March and October 2020 who were not enrolled in January or February, 2020. Disenrollment included persons who were enrolled in March of 2020 but not enrolled in October 2020. The study included 8.50 million Medicaid enrollees in 2020 and 8.46 million in 2019. Overall, enrollment increased by 13.0% (1.19 million) in the selected states during the PHE compared to 2019. New enrollment accounted for 24.9% of the relative increase, while the remaining 75.1% was due to disenrollment. A larger proportion of new enrollment in 2020 was among adults aged 27 to 44 (28.3% vs 23.6%), Hispanics (34.3% vs 32.5%) and in the financial needy (44.0% vs 39.0%) category compared to 2019. Disenrollment included a larger proportion of older adults (26.1% vs 8.1%) and non-Hispanics (70.3% vs 66.4%) than in 2019. Medicaid enrollment grew considerably during the PHE, and most enrollment growth was attributed to decreases in disenrollment rather than increases in new enrollment. Our results highlight the impact of coronavirus disease 2019 on state health programs and can guide federal and state budgetary planning once the PHE ends.

Changes in Health Care and Prescription Medication Affordability in the US During the COVID-19 Pandemic

“…We found that public health insurance coverage (eg, Medicaid) during the COVID-19 pandemic remained high and actually improved for low-income adults, likely due to federal policies that increased Medicaid funding in exchange for states suspending eligibility redeterminations and maintaining coverage for enrollees through the end of the public health emergency. 31 , 32 , 33 The federal government also temporarily expanded eligibility for tax credits and created an open enrollment period for Affordable Care Act marketplace health insurance plans. 11 While growth in health insurance coverage during the COVID-19 pandemic did not explain the improvements in health care and prescription medication affordability observed in our study, these federal policies likely prevented coverage and affordability from worsening for low-income adults.…”

State-to-State Variation in Medicaid Reimbursement for Neurosurgical Procedures: Implications for Healthcare Access in Vulnerable Populations

“…Through the lens of neurosurgical payment, this study highlights broader Medicaid challenges related to reimbursement and access to care. 40,41 Additional concerns not addressed here include the program's history of complex administrative burden and reimbursement delays, 41 increasing enrollment despite limited funding, 42,43 and gaps in coverage because of variable eligibility requirements. 44,45 Exemplifying the provider burden, it is estimated that there are over 130 000 pages of regulations that clinicians must be familiar with to be renumerated for treating Medicaid patients.…”

Psychiatric Boarding Patterns Among Publicly Insured Youths Evaluated by Mobile Crisis Teams Before and During the COVID-19 Pandemic

“…Publicly insured youths with psychiatric illnesses are among the most vulnerable populations in the US; however, few studies have examined to what extent the pandemic has been associated with the use of PES among publicly insured youths. By the end of the pandemic, more than 50% of children in the US were covered by public insurance . Moreover, Medicaid is an important source of insurance for children and young adults with behavioral health conditions .…”

“…By the end of the pandemic, more than 50% of children in the US were covered by public insurance. 27,28 Moreover, Medicaid is an important source of insurance for children and young adults with behavioral health conditions. 29 National estimates of PES rates during the COVID-19 pandemic comingled the publicly and privately insured children's…”