A look back on 10 years of research
Sa’Ra Skipper and her sister both have diabetes. But a few years ago, when Skipper found herself no longer eligible for Medicaid coverage and unable to afford insulin, her sister decided to skip doses of her own medication and give some to Skipper—a sacrifice that almost cost her life. “That was a really rough time, to see my sister lying in a hospital bed because she was just trying to help me out … she kept me alive,” Skipper told a Human Rights Watch reporter in 2018. An incident such as this highlights the types of risks individuals may be forced to take as a result of Medicaid churn, the phenomena of periodic disenrollment from Medicaid followed by re-enrollment. With the end of the pandemic-era continuous enrollment requirement on March 31, churn is once again a hot topic.Medicaid coverage loss is not a new phenomenon. In the last decade research has found three consistent, critical trends about the effects of Medicaid churn —on the individuals, groups and the broader healthcare system.
1. Individual coverage gaps are the most consistent, direct result of Medicaid loss.
While some people who lose Medicaid coverage immediately transition to comparable private insurance, they’re in the minority. A study by the Kaiser Family Foundation (KFF) found 66 percent of people disenrolled from Medicaid remain uninsured for some time. Moreover, a study by the non-profit Commonwealth Fund discovered 23 percent of Americans without Medicaid are in a situation like Skipper’s: insured, but by a plan that doesn’t cover all their medical needs.
2. Total medical costs – and hospital stay lengths – skyrocket.
Disenrollment often causes delays in diagnosis and treatment because those without insurance coverage do not seek care until they are re-enrolled or until they can enroll in alternate insurance. These delays impose high costs. One study showed Medicaid disenrollment delayed breast cancer diagnoses until late-stage disease. These delays create the need for more acute care, care that is often more intensive and expensive than the care required when a diagnosis is made earlier.
3. Higher rates of premature death connected to lost coverage.
Research from the Center on Budget and Policy Priorities (CBPP) demonstrates state Medicaid expansion may have contributed to 19,000 in the 55-64 age group living longer lives in the three-year analysis period (2014-2017). Yet, in states where Medicaid coverage was not expanded in that period, CBPP calculates approximately 15,600 adults in this age bracket died prematurely, due lack of access to care and services. Per the CBPP’s report, the annual mortality rate for older adults, under 65, decreases by up to 64 percent when those adults are covered by Medicaid. Adults over 65 are less affected by Medicaid coverage loss because they qualify for Medicare.
Automated Enrollments Reduce Risks
While there’s no easy fix for the problem, there are things we can do to make a difference. FEI’s Blue Compass case management solutions help streamline enrollment and prevent unnecessary disenrollment from state waiver programs, and that’s one of the ways we can help alleviate Medicaid churn.
FEI’s comprehensive case management solutions:
- Automate key enrollment and re-enrollment processes
- Generate system-based alerts and notifications for specified staff, to maintain efficient workflows and escalate if timelines are at risk.
- Support and effectively capture data via patients’ preferred communication methods to improve engagement
- Allow for easy reporting of all enrollment activities
FEI stands ready to support our state and local partners in their efforts to reduce Medicaid churn in the wake of the unwinding of the continuous enrollment requirement in place during the PHE.
