Disruptions In Medicaid Coverage For Depression Linked To Increased ER Visits

MedicalResearch.com Interview with:
Xu Ji PhD Candidate
Emory University
Department of Health Policy and Management
Rollins School of Public Health
Emory University
Atlanta, GA

What is the background for this study? What are the main findings?

Response: Gaps in Medicaid coverage (sometimes called “churning”) can disrupt ongoing outpatient care needed to manage chronic conditions, such as depression, and trigger use of emergency care. This study examined how disruptions in Medicaid coverage impacted acute care use—specifically emergency department visits and hospital stays—in nearly 140,000 adults treated for major depression.

We found that those with disruptions in Medicaid coverage were more likely to have emergency department visits and longer hospital stays when they went back on Medicaid compared to those with continuous coverage.

We also found that disruptions in Medicaid coverage occurred less frequently for Medicaid enrollees with depression in states requiring only yearly recertification (i.e., more streamlined re-enrollment procedures) than those in states that required recertification every six months or more frequently (i.e., more stringent procedures). Eligibility recertification usually requires enrollees to visit the social welfare office to provide income or other documentation to prove eligibility. Failure to complete the recertification process would drop enrollees out of Medicaid.

What should readers take away from your report?

Response: Disruptions in Medicaid coverage can be especially problematic for those with depression. When these individuals lose Medicaid without an alternative source of insurance coverage, they may end up skipping doctors’ visits until their mental health symptoms worsen to the extent that emergency care and hospitalizations are required.

Medicaid enrollees who live in states with more streamlined re-enrollment policies (annual recertification) are more likely to experience continuous Medicaid enrollment, compared to those living in states that require recertification more frequently.

Under the Affordable Care Act, states are required to recertify Medicaid eligibility no more frequently than annually for beneficiaries who qualify based on income. Proposals that are being considered in Congress would give states more authority in administrating their Medicaid programs and include an option of re-determining eligibility every six months or more frequently. If the proposed policies are passed into law and states opt to increase the frequency of their Medicaid recertification to once every six months or more often, this could have implications for coverage disruptions among those with depression.

Our findings indicate that these coverage disruptions can lead to poorer health outcomes requiring the use of costly services delivered in hospital acute care settings for those who re-enroll at a later date.

What recommendations do you have for future research as a result of this study?

Response: This study showed that for those with severe depression, disrupted coverage could contribute to elevated acute care services for those that re-enrolled in Medicaid at a later date. Future research may investigate whether and what types of adverse health outcomes occur as a result of disruptions in Medicaid coverage among vulnerable populations with mental health disorders. Future studies may also extend beyond those with mental health disorders to examine the consequences of Medicaid coverage disruptions among those with other types of chronic conditions that require ongoing care maintenance.

The authors declare no conflict of interest.


Discontinuity of Medicaid Coverage: Impact on Cost and Utilization Among Adult Medicaid Beneficiaries With Major Depression

Ji, Xu MSPH; Wilk, Adam S. PhD; Druss, Benjamin G. MD, MPH; Lally, Cathy MSPH; Cummings, Janet R. PhD

Medical Care: August 2017 – Volume 55 – Issue 8 – p 735–743
doi: 10.1097/MLR.0000000000000751
Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

Last Updated on July 31, 2017 by Marie Benz MD FAAD