Medicaid Unwinding Linked to Prescription Loss in Children and Young Adults, Study Shows

More children and young adults with chronic conditions such as depression and asthma experienced prescription disruptions in states with the biggest drops in Medicaid enrollment during the “unwinding process” when compared to states with smaller drops, according to a recent study done by the University of Michigan and published in Pediatrics.

This study was conducted by a team at the University of Michigan’s Susan B. Meister Child Health Evaluation and Research Center (CHEAR) and led by Kao-Ping Chua, M.D., Ph.D., a pediatrician and health care researcher at the University of Michigan Medical School and School of Public Health.

“Our findings suggest that the rapid disenrollment of young people from Medicaid during the unwinding process resulted in the disruption of chronic disease therapy,” Chua said in the study. “As policymakers debate whether to enact drastic cuts to Medicaid funding, they should consider the possibility that doing so could similarly disrupt chronic disease therapy for children and young adults, placing them at higher risk for disease exacerbations and absenteeism from school and work.”

Chua and his team analyzed prescription data from patients ages 0 to 25 using the 2017–2023 IQVIA Longitudinal Prescription Database, which captures data from 92% of prescriptions filled at U.S. pharmacies. The medications were organized into five classes:

• attention-deficit/hyperactivity disorder medications
• antidepressants
• antiepileptics
• antipsychotics
• inhaled steroids

Young adults ages 19 to 25 were the age group most likely to stop filling prescriptions due to loss of Medicaid coverage if they lived in states that had bigger drops in adult Medicaid enrollment, compared with those living in states with smaller drops. Young adults living here had a decrease in prescriptions for 2 classes and were at risk for having no prescriptions or 1 or more cash-pay prescriptions for all classes.

"One potential reason is that parents may be willing to make great financial sacrifices to pay for their child’s medications even if the child loses Medicaid coverage and becomes uninsured," Chua said in an email interview. "Young adults do not always have access to their parents’ financial resources."

For young adult disenrollment, states such as Idaho, Kansas and Montana saw disenrollment rates of 19% or more on the higher end. The smallest drops (8% or less) occurred in states such as Nevada, Virginia and Wisconsin.

Seventeen percent of children living in high disenrollment states saw a drop in prescription access, specifically, a decrease in prescriptions for at least 1 class and a risk of decrease in 1 or more cash-pay prescriptions for 3 classes. The states with the smallest drops, including Maryland, Maine and North Carolina, saw enrollment drops of 4% or less.

During the COVID-19 pandemic, states continuously enrolled Medicaid beneficiaries in exchange for increased federal funding due to Congress’s Families First Coronavirus Response Act (FFCRA). This resulted in a total of 94 million enrollees in March 2023—up 23 million from the previous year. As of April 1, 2023, states have been ending coverage for people deemed ineligible or whose redetermination can’t be completed. As of Sept. 12, 2024, more than 25 million people have been disenrolled and more than 56 million have had their coverage renewed. Among those who were disenrolled, 69% were disenrolled because of paperwork or procedural reasons, according to KFF data.

“To reverse these disruptions, policymakers could find alternative sources of coverage for disenrolled patients who are no longer eligible for Medicaid and reenroll eligible patients who were disenrolled from Medicaid for procedural

reasons,” Chua and his team write in the study. “To reverse disruptions among young adults specifically, policymakers in states that have not expanded Medicaid under the Affordable Care Act could consider doing so, as such expansions have been particularly beneficial for young adults with low income.”