Trends in Medicaid Enrollment and Disenrollment During the Early Phase of the COVID-19 Pandemic in Wisconsin

Abstract

IMPORTANCEAfter the federal public health emergency was declared in March 2020, states could qualify for increased federal Medicaid funding if they agreed to maintenance of eligibility (MOE) provisions, including a continuous coverage provision. The implications of MOE provisions for total Medicaid enrollment are unknown. OBJECTIVE To examine observed increases in Medicaid enrollment and identify the underlying roots of that growth during the first 7 months of the COVID-19 public health emergency in Wisconsin. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study compared changes in Wisconsin Medicaid enrollment from March through September 2020 with predicted changes based on previous enrollment patterns (January 2015-September 2019) and early pandemic employment shocks. The participants included enrollees in full-benefit Medicaid programs for nonelderly, nondisabled beneficiaries in Wisconsin from March through September 2020. Individuals were followed up monthly as they enrolled in, continued in, and disenrolled from Medicaid. Participants were considered to be newly enrolled if they enrolled in the program after being not enrolled for at least 1 month, and they were considered disenrolled if they left and were not reenrolled within the next month. EXPOSURES Continuous coverage provision beginning in March 2020; economic disruption from pandemic between first and second quarters of 2020. MAIN OUTCOMES AND MEASURES Actual vs predicted Medicaid enrollment, new enrollment, disenrollment, and reenrollment. Three models were created (Medicaid enrollment with no pandemic, Medicaid enrollment with pandemic economic circumstances, and longer Medicaid enrollment with a pandemic-induced recession), and a 95% prediction interval was used to express uncertainty in enrollment predictions. RESULTS The study estimated ongoing Medicaid enrollment in March 2020 for 792 777 enrollees (mean [SD] age, 20.6 [16.5] years; 431 054 [54.4%] women; 213 904 [27.0%] experiencing an employment shock) and compared that estimate with actual enrollment totals. Compared with a model of enrollment based on past data and incorporating the role of recent employment shocks,most ongoing excess enrollment was associated with MOE provisions rather than enrollment of newly eligible beneficiaries owing to employment shocks. After 7 months, overall enrollment had increased to 894 619, 11.1% higher than predicted (predicted enrollment 805 130; 95% prediction interval 767 991-843 086). Decomposing higher-than-predicted retention, most enrollment was among beneficiaries who, before the pandemic, likely would have disenrolled within 6 months, although a substantial fraction (30.4%) was from reduced short-term disenrollment.

Changes in Health Care Access by Race, Income, and Medicaid Expansion During the COVID-19 Pandemic

“…Taken together, our findings suggest modest improvements in overall insurance coverage within Medicaid expansion states during the COVID-19 pandemic. Our results also comport with prior work suggesting a shift toward public coverage may have blunted pandemic-related losses of employer-sponsored health insurance 23,24. Moreover, these results reinforce the value of Medicaid expansion as one tool to improve access to health insurance and care for marginalized and vulnerable populations, even during intersecting public health and economic crises.…”

“…Consequently, the increase in Medicaid enrollment is attributable to greater continuity of existing coverage in addition to an influx of new enrollees. 24 …”

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

“…This finding builds on prior work that Wisconsin Medicaid enrollment during the PHE was predominantly due to the continued coverage rather than new enrollees. [15] Our work shows similar results across multiple states. To the extent to which the reduction of enrollment is due to policy changes like FFCRA, policies appear to have reduced instability in Medicaid access and promote continuity of coverage during this time.…”

“…[ 13 ] Responding to the FFCRA, states extended eligibility for individuals already enrolled in Medicaid who might otherwise have become ineligible. [ 9 , 14 ] Accordingly, a recent study in a single state suggested that Medicaid enrollment during the PHE was largely due to the maintenance of continuous coverage rather than new enrollees due to unemployment [ 15 ] and another study found a significant increase in enrollment for safety net programs during the PHE. [ 16 ] However, analyses have not assessed the relative importance of increased new enrollment as compared with reduced disenrollment as drivers of increased total enrollment.…”

Medicaid Disenrollment After the COVID-19 Pandemic

“…This churning (exiting and then re-entering the program) has been associated with disruptions in access to care and negative health outcomes. 3 In their study published in JAMA Health Forum, Dague and colleagues 4 used Medicaid administrative data from Wisconsin to decompose whether increases in the state's Medicaid enrollment were driven by the FFCRA continuous coverage provisions or by the economic disruptions brought on by the pandemic. This analysis is timely and important for policy makers: the former (FFCRA provisions) would suggest states may experience a sharp spike in disenrollment when the PHE ends, rather than gradual changes in coverage as the economy improves.…”