Chris Frenier and Adrianna McIntyre asked a very policy relevant question in JAMA Network Open:
When people get disenrolled from Medicaid, what happens to their coverage in six and twelve months
They used the Minnesota All Payer Claims Database to track where disenrolled Medicaid Enrollees have coverage in the next six and twelve months. The data source is probably one of the better ones nationally but it is still flawed as it is not able to require data from large self-insured employer groups so there is a lot of missingness nor does it track people who move out of state. But even with that, it still provides a lot of insight.
At six months, disenrolled kids have about a 50% chance of not being observed in the database. At twelve months, about 30% of the kids are not observed in the database. Some of this is known missingness. A lot is likely uninsurance. At a year, half the kids are back on Medicaid. Rushina Cholera, myself and other Duke co-authors found similar results in North Carolina during the same time period of this study. Adults have 50% missing from the database in six months and 40% missing from the database in 12 months.
The big and important thing as the country is currently redetermining Medicaid eligibility is the ACA marketplaces aren’t picking up a ton of new enrollments. About 5% to 6% of adults are enrolling in ACA plans and even fewer kids are enrolling in ACA plans after they lose Medicaid.
This is massively problematic.
Perhaps the enhanced subsidies will help, but that is a big hope for modest money and behavioral frictions that have to be overcome.