The Article in Brief

Short-term Impacts of Coverage Loss in a Medicaid Population: Early Results From a Prospective Cohort Study of the Oregon Health Plan

Matthew J. Carlson, PhD, and colleagues

Background The expansion of Medicaid programs over the past 20 years has improved access to health care for millions of low-income Americans. In recent years, however, states have reduced Medicaid spending to save costs. This study examines the immediate effects of disrupted or lost medical coverage on adults enrolled in Medicaid. In particular, the study looks at the effect of changes in Medicaid in the Oregon Health Plan (OHP) implemented in February, 2003.

What This Study Found Nearly one half (45%) of those enrolled in the OHP Standard plan experienced disrupted or lost medical coverage in the first 10 months after the plan was redesigned. In contrast, during the same period 1 year earlier, enrollment declined by only 3%. Those who lost coverage reported significantly worse access to health care and medication and higher medical debt than those with stable coverage. In addition, those whose insurance coverage was disrupted were less likely to get needed medical care and less likely to be able to afford needed prescription medicine than those with stable coverage.

Implications

• Changes in the Oregon Health Plan resulted in immediate loss of medical coverage, unmet health care needs, and increased debt for many low-income adults.
• Even short gaps in medical coverage can result in less access to health care and more financial burden.
• Those whose access to health care and medications is reduced in the short-term may have worse health with time, and may be more likely to need emergency department or hospital services.
• Because most states in the US have made changes to their Medicaid programs similar to those in Oregon, this research has national implications.