Payers

Analysis: Medicaid-eligible, but unenrolled adults have worse health outcomes, more barriers to care

The study’s authors contended that the results “underscore that having health insurance promotes health and financial well-being.”
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File under Not Surprising: Medicaid-eligible adults who lack health coverage are more likely than their insured counterparts to have worse health outcomes and face challenges when it comes to accessing care. That’s the major takeaway from an Urban Institute and Robert Wood Johnson Foundation analysis released on August 29.

The study compared adults who are eligible for Medicaid but not enrolled in the public health insurance to Medicaid recipients and low-income individuals with private health insurance. The analysis found that unenrolled, Medicaid-eligible individuals were less likely to utilize healthcare services, more likely to delay care due to costs, and face higher out-of-pocket expenses when they did access care.

The study’s authors contended that the results “underscore that having health insurance promotes health and financial well-being.”

The findings come as states reconsider which Medicaid enrollees are still eligible for the public health insurance program—a process that was largely halted during the Covid-19 pandemic as the federal government offered states financial incentives for not kicking people off of their Medicaid rolls.

The findings

Specifically, the analysis found that fewer than four in 10 Medicaid-eligible but unenrolled adults (37%) reported having a consistent source of healthcare, compared to 70% of Medicaid enrollees and 67% of Medicaid-eligible adults with private insurance.

Adults who are eligible for Medicaid but not enrolled in the program were also 3x more likely to delay care than Medicaid recipients with similar incomes—21% compared to 7%—and about 2x more likely than Medicaid-eligible adults with private insurance to do so—21% versus ~10%, respectively—according to the analysis.

Less than a quarter of uninsured, Medicaid-eligible adults (23%) said they had visited a doctor in the last year, compared to 65% of Medicaid enrollees. And just 28% said they had a prescription filled in the last year, compared to 67% of Medicaid recipients.

Why it matters

Bowen Garrett, an Urban Institute senior fellow, said that “while Medicaid-eligible, uninsured adults do have contingent coverage in the event they go to the hospital, for healthcare needs below that threshold, [the] research suggests this group faces barriers to care, and has access problems, reduced utilization, and out-of-pocket spending burdens similar to other uninsured groups.”

An estimated 17%–20% of uninsured people—or about 5–6 million individuals—were eligible for but not enrolled in Medicaid or the Children’s Health Insurance Program in 2019 and 2020, researchers noted. Those people can still benefit from provisional Medicaid coverage, but may not be aware of their eligibility.

Katherine Hempstead, a senior policy advisor at the Robert Wood Johnson Foundation, added that “in the context of ongoing Medicaid redetermination, this suggests the possibility of significant financial and health outcomes resulting from administrative churn.”

“Not surprisingly, those who are eligible for Medicaid but not enrolled spend more for care and have more unmet needs than their counterparts who are enrolled,” she said in a statement.

Navigate the healthcare industry

Healthcare Brew covers pharmaceutical developments, health startups, the latest tech, and how it impacts hospitals and providers to keep administrators and providers informed.