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Medicaid Coverage Disruptions Among Children Enrolled in North Carolina Medicaid From 2016 to 2018.

Publication ,  Journal Article
Cholera, R; Anderson, D; Raman, SR; Hammill, BG; DiPrete, B; Breskin, A; Wiener, C; Rathnayaka, N; Landi, S; Brookhart, MA; Whitaker, RG ...
Published in: JAMA Health Forum
December 2021

IMPORTANCE: Brief disruptions in insurance coverage among eligible participants are associated with poorer health outcomes for children. OBJECTIVE: To describe factors associated with coverage disruptions among children enrolled in North Carolina Medicaid from 2016 to 2018 and estimate the outcome of preventing such disruptions on medical expenditures. DESIGN SETTING AND PARTICIPANTS: This was a retrospective cohort study using North Carolina Medicaid claims data. All enrolled individuals were aged 1 to 20 years on January 1, 2016, and with 30 days of prior continuous enrollment. Children were observed from January 1, 2016, until December 31, 2018. Analyses were conducted from June 2020 through December 2020. MAIN OUTCOMES AND MEASURES: Risk of Medicaid coverage disruptions of 1 to less than 12 months was assessed. Among children who disenrolled from Medicaid for 30 or more days, the risk of reenrollment within 1 to 6 months and 7 to 11 months was assessed. An inverse probability of censoring weights method was then used to estimate the outcome of an intervention to reduce coverage disruptions through preventing disenrollment on per member per month (PMPM) cost. RESULTS: The study population included 831 173 Medicaid beneficiaries aged 1 to 5 years (23%), 6 to 17 years (68%), and 18 to 20 years (9%); 35% were Black, 44% were White, and 14% were Hispanic/Latinx. Among those with a first disenrollment (n = 214 401, 26%), the risk of reenrollment within 6 months and 7 to 11 months was 19% and 7%, respectively. Risk of coverage disruption was higher for Black children (hazard ratio [HR], 1.21; 95% CI, 1.18-1.24), children of other races (Asian, American Indian, Hawaiian or Pacific Islander, multiple races, or unreported; HR, 1.37; 95% CI, 1.33-1.40), and Latinx children (HR, 1.65; 95% CI, 1.60-1.70) compared with White children. Risk of coverage disruption was also higher for children with higher medical complexity (HR, 1.15; 95% CI, 1.12-1.19). The risk of coverage disruption was lower for children living in counties with the highest unemployment rates (HR, 0.89; 95% CI, 0.85-0.94), and comparisons between county-level measures of child poverty and graduation rates showed little or no difference. The estimated PMPM cost for the full population under a scenario in which all medical costs were included was $125.73. Estimated PMPM cost for the full cohort in a counterfactual scenario in which disenrollment was prevented was slightly lower ($122.14). Across all subgroups, estimated PMPM costs were modestly lower ($2-$8) in the scenario in which disenrollment was prevented. CONCLUSIONS AND RELEVANCE: In this cohort study, the risk of Medicaid coverage disruption was high, with many eligible children in historically marginalized communities continuing to experience unstable enrollment. In addition to improving health outcomes, preventing coverage gaps through policies that decrease disenrollment may also reduce Medicaid costs.

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Published In

JAMA Health Forum

DOI

EISSN

2689-0186

Publication Date

December 2021

Volume

2

Issue

12

Start / End Page

e214283

Location

United States

Related Subject Headings

  • United States
  • Retrospective Studies
  • North Carolina
  • Medicaid
  • Insurance Coverage
  • Humans
  • Cohort Studies
  • Child
 

Citation

APA
Chicago
ICMJE
MLA
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Cholera, R., Anderson, D., Raman, S. R., Hammill, B. G., DiPrete, B., Breskin, A., … Wong, C. A. (2021). Medicaid Coverage Disruptions Among Children Enrolled in North Carolina Medicaid From 2016 to 2018. JAMA Health Forum, 2(12), e214283. https://doi.org/10.1001/jamahealthforum.2021.4283
Cholera, Rushina, David Anderson, Sudha R. Raman, Bradley G. Hammill, Bethany DiPrete, Alexander Breskin, Catherine Wiener, et al. “Medicaid Coverage Disruptions Among Children Enrolled in North Carolina Medicaid From 2016 to 2018.JAMA Health Forum 2, no. 12 (December 2021): e214283. https://doi.org/10.1001/jamahealthforum.2021.4283.
Cholera R, Anderson D, Raman SR, Hammill BG, DiPrete B, Breskin A, et al. Medicaid Coverage Disruptions Among Children Enrolled in North Carolina Medicaid From 2016 to 2018. JAMA Health Forum. 2021 Dec;2(12):e214283.
Cholera, Rushina, et al. “Medicaid Coverage Disruptions Among Children Enrolled in North Carolina Medicaid From 2016 to 2018.JAMA Health Forum, vol. 2, no. 12, Dec. 2021, p. e214283. Pubmed, doi:10.1001/jamahealthforum.2021.4283.
Cholera R, Anderson D, Raman SR, Hammill BG, DiPrete B, Breskin A, Wiener C, Rathnayaka N, Landi S, Brookhart MA, Whitaker RG, Bettger JP, Wong CA. Medicaid Coverage Disruptions Among Children Enrolled in North Carolina Medicaid From 2016 to 2018. JAMA Health Forum. 2021 Dec;2(12):e214283.

Published In

JAMA Health Forum

DOI

EISSN

2689-0186

Publication Date

December 2021

Volume

2

Issue

12

Start / End Page

e214283

Location

United States

Related Subject Headings

  • United States
  • Retrospective Studies
  • North Carolina
  • Medicaid
  • Insurance Coverage
  • Humans
  • Cohort Studies
  • Child