After Enrolling in Virginia’s Expanded Medicaid Program, Low-Income People Reported Fewer Worries About Household Finances and Medical Bills One Year After Enrollment Compared to the Year Before Enrollment, New Research Shows conducted by scientists from Virginia Commonwealth University School of Medicine.
The studypublished in the journal Health Affairs, is the first in the United States to analyze changes in subjective financial distress in a population of new Medicaid enrollees before and after enrollment.
“Since the expansion of Medicaid in Virginia in 2019, health insurance coverage has been extended to more than 500,000 adults,” said Hannah Shadowen, MD-Ph.D. student in the VCU School of Medicine Department of Health Behavior and Policy and lead author of the new study. “Through this research, we are taking a closer look at how expanding Medicaid could create positive financial change and improve equity for low-income families.”
The study is part of a larger five-year Medicaid expansion assessment that VCU is leading on behalf of Virginia. Department of Medical Assistance Services. The assessment is led by Peter Cunningham, Ph.D., professor in the Department of Health Behavior and Policy at the VCU School of Medicine, and Andrew Barnes, Ph.D., also a professor in the Department of Health Behavior and Policy.
The research team conducted a baseline survey of people newly eligible for Medicaid to understand their health care experience and financial situation in the year prior to enrollment. Follow-up surveys were then sent more than 18 months after enrollment. The team collected over 3,000 responses in total.
Using data from the surveys, the researchers examined changes in financial concerns about medical and non-medical needs for recipients one year after enrollment. This included worries about paying for housing, food, monthly bills, credit card and loan payments, and health care.
“Most studies that examine the financial implications of Medicaid expansion focus on health care affordability or catastrophic financial events like bankruptcy. In this research, we wanted to see if enrollment in the program also impacts a person’s ability to pay for household expenses like housing and food,” said study co-author Barnes.
The research team’s analysis showed that after 12 months of enrollment in Medicaid, enrollees were 33.7% less likely to be concerned about normal healthcare costs and 23.8% less likely to be concerned about catastrophic health care costs compared to the previous year. Enrolled respondents also reported having less difficulty paying medical bills and repaying medical debt over time.
Additionally, the researchers found that enrollees showed less concern about general non-healthcare related expenses. These results were consistent with previous studies that showed positive impacts of Medicaid expansion on nonmedical costs.
Reported changes in financial need after enrolling in Medicaid were broadly similar across all demographic subgroups, including gender, rurality, race, and ethnicity.
“Medicaid is a critical anti-poverty program, but it’s important to understand whether the positive results of the program are extended to all different types of Medicaid members,” Shadowen said. “It is very encouraging to see that low-income families from different backgrounds have all experienced similar positive effects from enrolling in Medicaid. In fact, where we found some differences in outcomes, people from historically marginalized groups experienced even more positive outcomes after enrollment. This is an encouraging sign that publicly funded coverage can actually promote health equity.
Since the follow-up surveys, conducted from August 2020 to May 2021, coincided with the COVID-19 pandemic, the results also added information on the impact of public health insurance during times of economic crisis and of public health.
“For many low-income families in the United States, Medicaid is an important social safety net. The COVID-19 pandemic has reinforced that role as millions of Americans have lost their jobs and employer health insurance coverage,” Barnes said. “Our findings offer evidence for the potentially critical role of Medicaid expansion in times of public health crisis and economic hardship.”
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