Dr Dennis Scanlon Discusses the Impact of the COVID-19 Pandemic on Medicaid Coverage

The end of the COVID-19 pandemic comes with new hurdles and fear of coverage gaps for states and individuals who are currently covered by Medicaid, says Dennis Scanlon, PhD, professor of health policy and administration, Penn State University.

Transcript

The US has had continuous Medicaid coverage for 3 years because of the pandemic, and that provision is now ending. What can states do to ensure that coverage gains are maintained with minimal disruption?

This really relates to the COVID-19 pandemic and the emergency authorization—basically, a public health emergency—to allow Medicaid beneficiaries to maintain their coverage and not have to go through re-enrollment or be kicked off of Medicaid coverage during that public health emergency. With that ending, it's going to require states to make decisions. I think we'll see variation across states and for beneficiaries on Medicaid, in terms of how this all plays out.

In some sense, it's part of, I guess you could call it maybe a natural experiment or a political experiment. A couple thoughts: One is, individuals maintaining health insurance coverage generally has shown to be beneficial for their health. A key question will be, of those who had maintained their coverage, how many are still eligible vs are no longer eligible because they don't meet the Medicaid coverage criteria? And there's variation in that and what it is. I would expect to see state-by-state variation.

If not covered by Medicaid, the question is, what other options does one have? Well, one has the Affordable Care Act exchanges, the ACA exchanges, with the subsidies that are available from the federal government, and then, of course, employment-based insurance or Medicare coverage as well. It's not that everyone that might no longer be eligible for Medicaid has no option, but the question is, do they take up that option? Can they afford that option? How do they get access and know about those options?

I think a lot of education is going to have to happen, but even on the re-enrollment side. How are states going to process and notify people that you may still be eligible, but you have to qualify, you have to re-enroll. For some of these individuals that first were covered by Medicaid and then the pandemic hit, this may be the first time that they go through that re-enrollment process. So, a lot of this is going to be really procedural and depend on how the different states [proceed], because we have, essentially, each state has its own Medicaid program, although it's jointly funded by the federal government. And of course, we know that Medicaid expansion was taken up by many, but not all states, as a result of the Affordable Care Act.

So, we will see some variation, but I think the key thing will be, are there gaps in coverage? What impact does that have on health, and ultimately, how much of the variation that might naturally occur from certain states to other states may allow us to understand the importance of insurance coverage, is kind of part of this experiment.