Medicaid new enrollee utilization during COVID

Today at Academy Health’s Annual Research Meeting, my co-author Brad Wright (UNC) is presenting work that he led with myself, Paul Shafer (BU), Rebecca Whitaker (Duke),  Janet Prvu-Bettger (DU), Peter Shrader (Duke)and Charlene Wong (Duke) on the writing team, which was funded by the Kate B Reynolds Charitable Trust.  We asked a simple question; given COVID being a huge employment and health shock, what were new Medicaid enrollees using for services in the first 60 days of their enrollment?

Medicaid has been a significant shock absorber of the COVID pandemic.  This is true in Expansion states.  This is true in non-Expansion states.  We hypothesized that new enrollees in a non-expansion state (North Carolina) would be healthier and use fewer services, even after we adjust for the fact that no one was using any elective services in April 2020, than previous groups of new enrollees.

We only looked at utilization and costs in the first sixty days of enrollment for North Carolina Medicaid enrollees from January 2018-August 2020. We found that new COVID period enrollees used a lot fewer services (30% to 52%) than new enrollees who enrolled before COVID was ever a thing that we knew about. We controlled for the COVID closure effects by estimating the changes in utilization for individuals who had a year of continual enrollment pre and post-COVID non-pharmaceutical interventions & closures. The dramatic reduction of physical movement and the significant narrowing of the appointment pipeline accounts for about two thirds of the drop in utilization.

The other one third drop in utilization is likely due to the changes in the health status and demographics of new enrollees.

We think that the new Medicaid enrollees post-COVID are fundamentally a bit healthier than new Medicaid enrollees pre-COVID. This will be important for state budgets as the cost of covering a healthier population is lower on a per member per month basis even if the covered population is a bit larger.