1. In this cohort study, over half of all beneficiaries of Medicaid in 2011 were still enrolled nine years later.

2. Both short and long-term Medical coverage stability rates were higher in persons with disabilities, who may depend on the program for regular care. 

Evidence Rating Level: 2 (Good)

Study Rundown: The Medicaid program was designed as a low-cost temporary insurance coverage solution for millions of low-income and marginalized Americans. Recent state-level policy changes and poor economic circumstances have increased the reliance on and stability of Medicaid coverage. This cohort study used enrollment data for beneficiaries of the Michigan Medicaid program between 2011 and 2020 to study short- and long-term program enrollment trends. The fixed cohort and newly-enrolled cohort are defined as Medicaid beneficiaries who were enrolled as of 1 January 2011 and those who were newly enrolled between 2011 and 2020, respectively. Over half of the fixed cohort was also enrolled in 2020, with the most stable demographic between persons with disabilities. One-quarter of the fixed cohort was enrolled continuously in the same period. In the newly enrolled cohort, 37% remained enrolled in 2020. About three-quarters of all beneficiaries were enrolled for at least two years. However, this trend dropped to 54% after 2015, which coincided with the Patient Protection and Affordable Care Act Medicaid expansion in 2014, which suggested that Medicaid continues to serve persons who only need the program temporarily. As a limitation, this analysis only included one state’s Medicaid program and could not differentiate mortality and disenrollment. These discrepancies may reduce generalizability to other states or misrepresent program stability.

Click to read the study in AIM

In-Depth [retrospective cohort]: In this retrospective cohort study, enrollment data for beneficiaries in the Michigan Medicaid program between 1 January 2011 and 30 June 2020 was used to study short- and long-term program enrollment trends. The fixed cohort and newly-enrolled cohort are defined as Medicaid beneficiaries who were enrolled as of 1 January 2011 and those who were newly enrolled between 1 February 2011 and 1 June 2020, respectively. In the fixed cohort, 54.8% of the 1,228,050 Medicaid beneficiaries were also enrolled nine years later in January 2020. Only 25.6% of the fixed cohort was continuously enrolled over the entirety of the nine-year period. On average, individuals in the fixed cohort were enrolled for 76.3 months. The most and least stable demographics were persons with disabilities and without disabilities, respectively. In the newly-enrolled cohort, 37.2% remained enrolled nine years after joining the Medicaid program. The two-year coverage stability rate was 67% to 72% for those newly enrolled between 2011 and 2014. This rate dropped to under 60% after 2015, which coincided with the Patient Protection and Affordable Care Act Medicaid expansion in 2014. According to this study, the Medicaid program represents a long-term source of insurance coverage. New policies and Medicaid infrastructure development to improve coverage stability would help to make the program more robust and catered to its beneficiaries.

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