A new paper came out that looked at individuals with depression who were covered by Medicaid. ** The paper looks at breaks in coverage and what happens to people when they get back onto Medicaid. It is both a painful humanitarian diseaster and expensive as hell.
Outcome Measures: Emergency department (ED) visits, inpatient episodes, inpatient days, and Medicaid-reimbursed costs.
Results: Approximately 29.4% of beneficiaries experienced coverage disruptions. In instrumental variables models, those with coverage disruptions incurred an increase of $650 in acute care costs per-person per Medicaid-covered month compared with those with continuous coverage, evidenced by an increase in ED use (0.1 more ED visits per-person-month) and inpatient days (0.6 more days per-person-month). The increase in acute costs contributed to an overall increase in all-cause costs by $310 per-person-month (all P-values<0.001).
The cost side is pretty straightforward. Making sure that people with depression have continual, low or no cost access to their prescriptions and other useful clinical support services saves money. The savings pathway is through far less inpatient utilization and a dramatic drop in emergency room utilization. Churn is expensive if the people being cut loose to fend for themselves without adequate resources have complex chronic conditions.
From a humanitarian point of view, the cost pathway is because people are suffering. I am lucky, depression is a monster I don’t have to fight. Several of my family members do struggle with depression and other mood disorders. They are able to maintain themselves but it is a continual struggle when they have resources. A downswing is not a good spot for them, it is not a good spot for the people that they live with, it is not good. And it is not good even without regard to economic costs. Churning people in and out of Medicaid means more people go into avoidable downswings that last long and go deeper than they otherwise should experience.
The current Senate bill will increase Medicaid churn. It will increase it in a variety of ways. First it will reduce Medicaid Expansion quickly and kill it over the long run. As people’s incomes move, they will earn out of Medicaid faster. Secondly, the Senate bill is allowing more frequent eligibility redeterminations. People will need to prove their eligibility more often which means people will fall out more frequently.
Churn is a cost killer. It also has incredible costs to the people who are being bounced in and out of coverage.
** Ji, X., Wilk, A. S., Druss, B. G., Lally, C., & Cummings, J. R. (2017). Discontinuity of Medicaid Coverage. Medical Care, 55(8), 735-743. doi:10.1097/mlr.0000000000000751