Abstract
Background and ObjectiveTo characterize health care use and costs among new Medicaid enrollees before and during the COVID pandemic. Results can help Medicaid non-expansion states understand health care use and costs of new enrollees in a period of enrollment growth.Research DesignRetrospective cross-sectional analysis of North Carolina Medicaid claims data (January 1, 2018 - August 31, 2020). We used modified Poisson and ordinary least squares regression analysis to estimate health care use and costs as a function of personal characteristics and enrollment during COVID. Using data on existing enrollees before and during COVID, we projected the extent to which changes in outcomes among new enrollees during COVID were pandemic-related.Subjects340,782 new enrollees pre-COVID (January 2018 – December 2019) and 56,428 new enrollees during COVID (March 2020 – June 2020).MeasuresWe observed new enrollees for 60-days after enrollment to identify emergency department (ED) visits, nonemergent ED visits, primary care visits, potentially-avoidable hospitalizations, dental visits, and health care costs.ResultsNew Medicaid enrollees during COVID were less likely to have an ED visit (-46 % [95 % CI: -48 %, -43 %]), nonemergent ED visit (-52 % [95 % CI: -56 %, -48 %]), potentially-avoidable hospitalization (-52 % [95 % CI: -60 %, -43 %]), primary care visit (-34 % [95 % CI: -36 %, -33 %]), or dental visit (-36 % [95 % CI: -41 %, -30 %]). They were also less likely to incur any health care costs (-29 % [95 % CI: -30 %, -28 %]), and their total costs were 8 % lower [95 % CI: -12 %, -4 %]. Depending on the outcome, COVID explained between 34 % and 100 % of these reductions.ConclusionsNew Medicaid enrollees during COVID used significantly less care than new enrollees pre-COVID. Most of the reduction stems from pandemic-related changes in supply and demand, but the profile of new enrollees before versus during COVID also differed.
Highlights
The COVID-19 pandemic led to significant economic hardship and unemployment
Most of the reduction stems from pandemic-related changes in supply and demand, but the profile of new enrollees before versus during COVID differed
Characteristics of the new Medicaid enrollee population are shown in Table 1, stratified by pre-COVID and COVID time periods
Summary
The COVID-19 pandemic led to significant economic hardship and unemployment. Newly uninsured adults and their families were expected to enroll in Medicaid— the health insurance program for low-income Americans—and to enroll at higher rates in Medicaid expansion states than non-expansion states (i.e., states that have used the Affordable Care Actto expand Medicaid eligibility to all individuals with incomes up to 138 % of the federal poverty level versus states that have not) [1,2,3]. In North Carolina, a Medicaid non-expansion state, total Medicaid enrollment increased by 7.3 % (from 2,071,904 to 2,223,768 enrollees) between February 2020 and August 2020 [4]. Understanding patterns of health care use and costs among new enrollees can provide states critical information for optimizing Medicaid programs. To characterize health care use and costs among new Medicaid enrollees before and during the COVID pandemic. Results can help Medicaid non-expansion states understand health care use and costs of new enrollees in a period of enrollment growth. Research Design: Retrospective cross-sectional analysis of North Carolina Medicaid claims data (January 1, 2018 August 31, 2020). We used modified Poisson and ordinary least squares regression analysis to estimate health care use and costs as a function of personal characteristics and enrollment during COVID. Using data on existing enrollees before and during COVID, we projected the extent to which changes in outcomes among new enrollees during COVID were pandemic-related.
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