Does Churning in Medicaid Affect Health Care Use?

Abstract

Background Transitions into and out of Medicaid, termed churning, may disrupt access to and continuity of care. Low-income, working adults who became eligible for Medicaid under the Affordable Care Act are particularly susceptible to income and employment changes that lead to churning. Objective To compare health care use among adults who do and do not churn into and out of Medicaid. Data Longitudinal data from 6 panels of the Medical Expenditure Panel Survey. Methods We used differences-in-differences regression to compare health care use when adults reenrolled in Medicaid following a loss of coverage, to utilization in a control group of continuously enrolled adults. Outcome Measures Emergency department (ED) visits, ED visits resulting in an inpatient admission, and visits to office-based providers. Results During the study period, 264 adults churned into and out of Medicaid and 627 had continuous coverage. Churning adults had an average of approximately 0.05 Medicaid-covered office-based visits per month 4 months before reenrolling in Medicaid, significantly below the rate of approximately 0.20 visits in the control group. Visits to office-based providers did not reach the control group rate until several months after churning adults had resumed Medicaid coverage. Our comparisons found no evidence of significantly elevated ED and inpatient admission rates in the churning group following reenrollment. Conclusions Adults who lose Medicaid tend to defer their use of office-based care to periods when they are insured. Although this suggests that enrollment disruptions lead to suboptimal timing of care, we do not find evidence that adults reenroll in Medicaid with elevated acute care needs.

Health Insurance Trajectories and Long-Term Survival After Heart Transplantation

“…[1][2][3][4][5]16,17 Compared with private insurance plans, public insurance programs may offer lower reimbursement rates, limiting physicians' participation and patients' access to care; 15 offer more limited medication coverage (eg, discontinuing coverage for outpatient immunosuppression medications after a certain time); 18 and may involve churn between eligibility and ineligibility for the public plan. 19 Limitations of public insurance are amplified by high costs of post-transplant care 20 and by high mortality risks among transplant recipients who cannot adhere to posttransplant treatment. 5 Sustained public insurance participation may also contribute to adverse outcomes because of poor access to primary care and worse control of comorbidities.…”

Discontinuity of Medicaid Coverage

“…Our study stands apart from previous studies of this relationship as we use national data to identify exogenous variation in states’ re-enrollment policy and use this variation as an instrumental variable (IV) to address sources of endogeneity. Importantly, this IV approach yields unbiased estimates of the effects of disenrollment on acute care (i.e., inpatient and/or emergency care) 22 utilization, which prior studies cannot claim.…”

Health Insurance Coverage Disruptions and Cancer Care and Outcomes: Systematic Review of Published Research

“…Research conducted in pediatric populations consistently shows that health insurance coverage disruptions are associated with reduced access to care (18). In the few studies of coverage disruptions conducted in adults, even a single loss of coverage of at least 1 month is associated with worse access to care (19), delaying or forgoing care (20), more emergency department use (15,21,22), and declines in overall health (15). Transitions between health plans can also disrupt access to usual source of care and provider networks.…”