Carrie Kozlowski Discusses the Impacts of the Medicaid Disenrollment Crisis

According to KFF's Medicaid Enrollment and Unwinding Tracker, a total of 16,430,000 Medicaid enrollees have been disenrolled across all 50 states and the District of Columbia, as of February 1, 2024. In reporting states, 33% of individuals who completed their renewal process experienced disenrollment, while 67%, equivalent to 32.5 million enrollees, had their coverage renewed. It was noted that due to variations in reporting timelines among states, the data presented may underestimate the actual number of disenrollments up to the current date.¹

Carrie Kozlowski, OT, MBA, COO, and co-founder of Upfront Healthcare, discussed the impact of increasing Medicaid disenrollment on the US health system.

Transcript

Can you describe the impact of the current Medicaid disenrollment on health systems, particularly in terms of financial challenges?

Sure, I'm excited and a little discouraged to be here talking about this. It's a big challenge, I think, right now in the country. I think when we think about the impact, I’ll cover a couple of areas. First, obviously, the financial impact. Patients still need care right now, right? So we have patients who need care, we're seeing the median rate of uncompensated care increase from early [20]23, at 6.4% to mid [20]23, up to 8.7%, so we know we're struggling from the perspective of finances. I also think, longer term, we're going to see more patients who are avoiding care due to not having the financial resources to get care, you know, delays further are going to be more expensive, need more care, obviously, as we go forward.

We're also seeing a pretty big exacerbation of more advanced disease and unexpected disease in our younger population. So where we historically think about the cost of our baby boomers and our Medicare age population—partially from COVID, where people delayed care and we saw an increase in health and behavioral health needs. But further, we're seeing really unusual stuff, like advanced colon cancer in young people, so that's also going to further impact revenue. I think quality is going to continue to be impacted as patients get sicker, we see safety net hospitals closing, so across the board, I think it's a pretty big impact.

The one area that I was talking with one of our clients in the last 2 weeks about—a pretty large for-profit health system—and what they're looking at is, “With our case mix, we can absorb the uncompensated care increase, and we're happy to do that and serve our charity care needs. But what we're struggling with is our hospitals are full. And as a result of patients being uninsured, we're having a really hard time transferring those patients to downstream facilities, like skilled nursing. So when patients are pending, you know, Title XIX, we are struggling, which is causing a throughput problem, backing up really [emergency department] and inpatient and delaying care for other patients that need to get into the facilities." So, there's also this impact that is much larger than financial and even this segment of the population, it's really the entire community that I think can be negatively impacted when we think at the macro level.

And then last, I was reading your article about the level of disparities that we're seeing with kids in terms of racial inequities, and, you know, 37% of kids were disenrolled from Medicaid over the last year. And so when you combine uninsured with the already existing significant racial inequities that we're seeing, I think we are heading towards a pretty big problem in an area of our population who I feel like we're pretty obligated to make sure that we're caring for in the United States.

Reference

Medicaid enrollment and unwinding tracker. KFF. February 1, 2024. Accessed February 6, 2024. https://www.kff.org/medicaid/issue-brief/medicaid-enrollment-and-unwinding-tracker/?mc_cid=f50ef0ecd6&mc_eid=2973aabf62