Continue Continuous Medicaid Eligibility, Says EAB Member Margaret A. Murray

One way the federal government responded to the COVID-19 pandemic was to temporarily increase the federal Medicaid matching rate by 6.2 percentage points. In exchange, states couldn’t add restrictions to eligibility and had to offer COVID-19 testing and treatment without cost sharing.

States who took advantage of the bump in the federal share also had to provide “continuously eligibility” — beneficiaries can’t be disenrolled from Medicaid coverage during the COVID-19 public health emergency, which started in January and doesn’t have an end date yet.

Now some advocates, policymakers and health plans want to see continuous Medicaid eligibility continue beyond the COVID-19 public health emergency.

“Continuous Medicaid eligibility would close some of the gaps in our insurance system and assure better access to care for a longer period," Margaret A. Murray, CEO of the Association for Community Affiliated Plans and a member of the Managed Healthcare Executive® editorial advisory board, said in a press release yesterday. So many people have postponed medical care amid the pandemic "the real need may not come until after the pandemic subsides,” Murray was quoted as saying in the press release.

The occasion for the press release was a working paper for Murray’s organization that examines the effects of continuous Medicaid eligibility for children. Before the COVID-19 outbreak, states had the option of extending 12 months of continuous Medicaid eligibility to children. The thinking is that children, in particular, shouldn't be in danger of losing health insurance coverage (and presumably access to care, including care that involves vaccinations) because of paperwork miscues, modest changes in family income, and the like. About half of the states took advantage of the option and had 12-month continuous Medicaid eligibility for children.

The working paper written by Leighton Ku, Ph.D., M.P.H., and Erin Brantley, Ph.D., M.P.H., of the Milken Institute School of Public Health at George Washington University compares outcomes for children from low-income families (incomes below 138% of poverty level) living in the 24 states with continuous Medicaid eligibility to outcomes for children in the 26 states and the District of Columbia without it. Ku and Brantley made the comparison by pooling data collected by HHS’ National Survey of Children’s Health from 2016 through 2018. The survey is a well-established research program conducted by the Census Bureau that involves asking families about children’s health.

In many respects, the findings are what you expect; for example, in states with continuous Medicaid eligibility, children had fewer gaps insurance. Continuous Medicaid eligibility was also associated with a greater use of preventive care visits and specialty visits and a larger difference — 6 percentage points — in reducing unmet needs for specialty care. A narrower analysis that focused just on children with special needs found that continuous Medicaid eligibility was associated with increases in general, preventive, and specialty care for those children.

But Ku and Brantley did not find an association between continuous Medicaid eligibility and better reported health status and fewer absences from school, outcomes that you might expect to see from what is, in essence, better insurance coverage.