Skip to main content
Erschienen in: Journal of General Internal Medicine 1/2009

01.01.2009 | Original Article

Loss of Health Insurance Among Non-elderly Adults in Medicaid

verfasst von: Benjamin D. Sommers, MD, PhD

Erschienen in: Journal of General Internal Medicine | Ausgabe 1/2009

Einloggen, um Zugang zu erhalten

ABSTRACT

BACKGROUND

Major policy efforts to expand health coverage to the uninsured are under consideration. Drop-out among children in Medicaid — due to annual renewal requirements — is well-documented, but the recent extent of this problem among non-elderly adults is unknown.

OBJECTIVE

To estimate the loss of health insurance over time among adults in Medicaid and identify risk factors for drop-out.

DESIGN

Survival analysis of Medicaid enrollment, using Kaplan-Meier curves and Cox proportional-hazards regression. Data are from the nationally representative Medical Expenditure Panel Survey, 2000–2004. The sample consists of non-elderly adults (n = 4,992) and children (n = 8,559) in Medicaid. Insurance status after 12 months was measured for all individuals enrolled in Medicaid at the survey’s outset. A survival analysis of disenrollment was then conducted for newly enrolled individuals.

RESULTS

Nationwide, 2 million adults leave Medicaid and become uninsured annually. Disenrollment was significantly higher among adults than children (hazard ratio 1.75, 95% CI 1.65–1.86). Respectively, 20%, 43%, and 55% of adults disenrolled within 6, 12, and 23 months of initial enrollment. Lost eligibility explained a small portion of disenrollment. Six months after disenrolling, 17% had reenrolled in Medicaid, 34% had other insurance, and 49% were uninsured. Men, younger adults, and Hispanics were more likely to drop out; those in Medicaid managed care or with disabilities were less likely. Overall health status and diseases, such as diabetes, heart disease, and depression, had no effect on drop-out.

CONCLUSIONS

Drop-out from Medicaid is a major problem among adults — even among those with chronic diseases — and contributes to the presence of millions of uninsured Americans. Policy efforts to expand health coverage must address poor Medicaid retention. Clinicians should be aware of this issue when caring for non-elderly adults in Medicaid.
Literatur
1.
Zurück zum Zitat DeNavas-Walt C, Proctor BD, Smith J. U.S. Census Bureau, Current Population Reports, P60-233. Income, poverty, and health insurance coverage in the United States: 2006. Washington, DC: U.S. Government Printing Office; 2007. DeNavas-Walt C, Proctor BD, Smith J. U.S. Census Bureau, Current Population Reports, P60-233. Income, poverty, and health insurance coverage in the United States: 2006. Washington, DC: U.S. Government Printing Office; 2007.
2.
Zurück zum Zitat Burton A, Friedenzohn I, Martinez-Vidal E. State strategies to expand health insurance coverage: Trends and lessons for policymakers. New York: Commonwealth Fund; 2007. Burton A, Friedenzohn I, Martinez-Vidal E. State strategies to expand health insurance coverage: Trends and lessons for policymakers. New York: Commonwealth Fund; 2007.
3.
Zurück zum Zitat Collins SR, Schoen C, Davis K, Gauthier AK, Schoenbaum SC. A roadmap to health insurance for all: Principles for reform. New York: Commonwealth Fund; 2007. Collins SR, Schoen C, Davis K, Gauthier AK, Schoenbaum SC. A roadmap to health insurance for all: Principles for reform. New York: Commonwealth Fund; 2007.
4.
Zurück zum Zitat Selden T, Hudson J, Banthin J. Tracking changes in eligibility and coverage among children, 1996–2002. Health aff. 2004;23:39–49.CrossRef Selden T, Hudson J, Banthin J. Tracking changes in eligibility and coverage among children, 1996–2002. Health aff. 2004;23:39–49.CrossRef
5.
Zurück zum Zitat Sommers BD. From Medicaid to uninsured: drop-out among children in public insurance programs. Health Serv Res. 2005;40:59–78.PubMedCrossRef Sommers BD. From Medicaid to uninsured: drop-out among children in public insurance programs. Health Serv Res. 2005;40:59–78.PubMedCrossRef
6.
Zurück zum Zitat Ellwood M, Lewis K. On and Off Medicaid: enrollment patterns for California and Florida in 1995. Washington, DC: Urban Institute; 1999. Ellwood M, Lewis K. On and Off Medicaid: enrollment patterns for California and Florida in 1995. Washington, DC: Urban Institute; 1999.
7.
Zurück zum Zitat Ku L, Ross DC. Staying covered: the importance of retaining health insurance for low-income families. Washington, DC: Center on Budget and Policy Priorities; 2002. Ku L, Ross DC. Staying covered: the importance of retaining health insurance for low-income families. Washington, DC: Center on Budget and Policy Priorities; 2002.
8.
Zurück zum Zitat Long SK, Coughlin T, King J. How well does Medicaid work in improving access to care? Health Serv Res. 2005;40:39–58.PubMedCrossRef Long SK, Coughlin T, King J. How well does Medicaid work in improving access to care? Health Serv Res. 2005;40:39–58.PubMedCrossRef
9.
Zurück zum Zitat Weissman JS, Stern R, Fielding SL, Epstein AM. Delayed access to health care: risk factors, reasons, and consequences. Ann Intern Med. 1991;114:325–31.PubMed Weissman JS, Stern R, Fielding SL, Epstein AM. Delayed access to health care: risk factors, reasons, and consequences. Ann Intern Med. 1991;114:325–31.PubMed
10.
Zurück zum Zitat McWilliams JM, Zaslavsky AM, Meara E, Ayanian JZ. Impact of Medicare coverage on basic clinical services for previously uninsured adults. JAMA. 2003;290:757–64.PubMedCrossRef McWilliams JM, Zaslavsky AM, Meara E, Ayanian JZ. Impact of Medicare coverage on basic clinical services for previously uninsured adults. JAMA. 2003;290:757–64.PubMedCrossRef
11.
Zurück zum Zitat Hadley J. Sicker and poorer: the consequences of being uninsured. Washington, DC: Urban Institute; 2002For an excellent review, see. Hadley J. Sicker and poorer: the consequences of being uninsured. Washington, DC: Urban Institute; 2002For an excellent review, see.
14.
Zurück zum Zitat Stata Corporation. Stata 7.0 statistical software. TX: College Station; 2001. Stata Corporation. Stata 7.0 statistical software. TX: College Station; 2001.
16.
Zurück zum Zitat Hill I, Lutzky AW. Is there a hole in the bucket? Understanding SCHIP Retention. Washington, DC: Urban Institute; 2003. Hill I, Lutzky AW. Is there a hole in the bucket? Understanding SCHIP Retention. Washington, DC: Urban Institute; 2003.
17.
Zurück zum Zitat Lewis K, Ellwood M. Children’s health insurance patterns: a review of the literature. Cambridge, MA: Mathematica Policy Research, Inc.; 1997. Lewis K, Ellwood M. Children’s health insurance patterns: a review of the literature. Cambridge, MA: Mathematica Policy Research, Inc.; 1997.
18.
Zurück zum Zitat Stuart B, Singhal P. The stability of Medicaid coverage for low-income dually eligible medicare beneficiaries. Kaiser Family Foundation Policy Brief (Publication #7512), 2006. Stuart B, Singhal P. The stability of Medicaid coverage for low-income dually eligible medicare beneficiaries. Kaiser Family Foundation Policy Brief (Publication #7512), 2006.
20.
Zurück zum Zitat Ross DC, Cox L. In a time of growing need: state choices influence health coverage access for children and families. Menlo Park, CA: Kaiser Family Foundation; 2005. Ross DC, Cox L. In a time of growing need: state choices influence health coverage access for children and families. Menlo Park, CA: Kaiser Family Foundation; 2005.
21.
Zurück zum Zitat Ross DC. New Medicaid citizenship documentation requirement is taking a toll. Washington, D.C.: Center on Budget and Policy Priorities; 2007. Ross DC. New Medicaid citizenship documentation requirement is taking a toll. Washington, D.C.: Center on Budget and Policy Priorities; 2007.
22.
Zurück zum Zitat Smith V, Gifford K, Ellis E, Wiles A, Rudowitz R, O’Malley M, Marks C. Low Medicaid spending growth amid rebounding state revenues: results from a 50-State Medicaid budget survey state fiscal years 2006 and 2007. Menlo Park, CA: Kaiser Family Foundation; 2006. Smith V, Gifford K, Ellis E, Wiles A, Rudowitz R, O’Malley M, Marks C. Low Medicaid spending growth amid rebounding state revenues: results from a 50-State Medicaid budget survey state fiscal years 2006 and 2007. Menlo Park, CA: Kaiser Family Foundation; 2006.
25.
Zurück zum Zitat Perry M, Kannel S, Riley T, Pernice C. What parents say: why eligible children LoseSCHIP. Portland, Maine: National Academy for State Health Policy; 2001. Perry M, Kannel S, Riley T, Pernice C. What parents say: why eligible children LoseSCHIP. Portland, Maine: National Academy for State Health Policy; 2001.
26.
Zurück zum Zitat Sommers BD. Protecting low-income children’s access to care: are physician visits associated with reduced patient drop-out from medicaid and the children’s health insurance program? Pediatrics. 2006;118:e36–42.PubMedCrossRef Sommers BD. Protecting low-income children’s access to care: are physician visits associated with reduced patient drop-out from medicaid and the children’s health insurance program? Pediatrics. 2006;118:e36–42.PubMedCrossRef
27.
Zurück zum Zitat Feinberg E, Swartz K, Zaslavsky AM, Gardner J, Walker DK. Language proficiency and the enrollment of Medicaid and CHIP-eligible children in publicly funded health insurance programs. Matern Child Health J. 2002;6:5–18.PubMedCrossRef Feinberg E, Swartz K, Zaslavsky AM, Gardner J, Walker DK. Language proficiency and the enrollment of Medicaid and CHIP-eligible children in publicly funded health insurance programs. Matern Child Health J. 2002;6:5–18.PubMedCrossRef
28.
Zurück zum Zitat Kaiser Family Foundation. The Medicaid program at a glance. Menlo Park, CA: Kaiser Commission on Medicaid and the Uninsured; 2006. Kaiser Family Foundation. The Medicaid program at a glance. Menlo Park, CA: Kaiser Commission on Medicaid and the Uninsured; 2006.
Metadaten
Titel
Loss of Health Insurance Among Non-elderly Adults in Medicaid
verfasst von
Benjamin D. Sommers, MD, PhD
Publikationsdatum
01.01.2009
Verlag
Springer-Verlag
Erschienen in
Journal of General Internal Medicine / Ausgabe 1/2009
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-008-0792-9

Weitere Artikel der Ausgabe 1/2009

Journal of General Internal Medicine 1/2009 Zur Ausgabe

Letter to the Editor

Response to Dawson and Arkes

Letter to the Editor

Letter to the Editor

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.