Earlier this week, I presented the following virtual poster at Academy Health’s 2021 Annual Research Meeting (ARM-21). I’m part of a team centered at Duke Margolis and funded by the Kate B. Reynolds Foundation to examine North Carolina Medicaid policy. As part of this remit, we looked at patterns of disenrollment and churn (coverage loss and then fairly rapid regain) for adults from 2016-2018. This poster focuses on Medicaid churn for post-partum women.
Medicaid pays for a significant number of all births in the country. Pregnant women have looser income qualification criteria for Medicaid than most other forms of Medicaid. In North Carolina, a single woman with no kids and in good health can not qualify for Medicaid at any income level. However, a pregnant woman can qualify for pregnancy Medicaid if she earns less than 196% Federal Poverty Level (FPL). This pregnancy eligibility expires 60 days after birth. At this point, a mother will either be moved to a different Medicaid eligibility group such as income based caregiver Medicaid where she can earn up 41% FPL for a family of two (or more) or she is disenrolled.
Not every woman who gives birth while insured by Medicaid is eligible via the pregnancy channel. Does this matter for disenrollment and churn?
Individuals who gave birth while eligible via the Aged, Blind, Disabled channel had a far lower risk of losing coverage at any point than any one else.
Individuals who were income qualified at the moment of birth have reasonably stable enrollment through the year post-partum.
Individuals who were on pregnancy Medicaid had significant coverage losses at the end of 60 days. Roughly a quarter of these individuals were disenrolled immediately at the end of sixty days. Three fifths were redetermined into the income qualified group.
We then looked at who disenrolled and came back.
Sicker individuals who lost coverage were more likely to re-enroll. Women who were covered in either income or the ABD eligibility groups were more likely to churn.
Why does this matter?
Insurance disruptions are care disruptions. The US has a significant maternal mortality problem. Churn (coverage loss and then coverage regain in a short time period) is likely indicative of administrative frictions rather than true eligibility losses. Fixing churn likely means more people will get insurance that they qualify for. The American Rescue Plan allows states to file a State Plan Amendment to extend the post-partum Medicaid eligibility period from 60 days to 1 year. This likely will reduce disenrollment and churn.