Most Who Lose Medicaid Have Trouble Finding Health Insurance

February 17, 1999

BOSTON - A study of Massachusetts residents who lost Medicaid-funded health coverage shows that most were unable subsequently to find sufficient health insurance for themselves and their children. Those who remained uninsured reported difficulty receiving needed services, even though most of them had access to a health care provider. The study led by researchers at the Massachusetts General Hospital (MGH) appears in the February issue of the Journal of Health Care for the Poor and Underserved.

The study's authors note that recent federal and state reforms have changed access to Medicaid, the government-funded program providing health services to low-income individuals. One major change is that recipients of welfare payments (AFDC or Aid to Families with Dependent Children) are no longer automatically eligible for Medicaid coverage.

Joel Weissman, PhD, the study's lead author, says, "We were interested is seeing what happens to people who've lost Medicaid coverage: whether they could find other insurance, whether their access to care was affected, and whether they could purchase insurance on their own."

Weissman is a member of the MGH-Partners Institute for Health Policy and assistant professor of Medicine (Health Policy) at Harvard Medical School (HMS). "What we found was that, even though these families maintained their relationships with safety-net health care institutions, they felt that their access to care was seriously compromised without Medicaid."

The researchers conducted a 1995-96 telephone survey of 351 current or former patients of Neighborhood Health Plan, a Boston-based health maintenance organization that operates largely through community health centers. Among respondents, 202 currently were enrolled in the local Medicaid program, called "Mass Health," and 149 had been terminated from Medicaid. Stated reasons for termination from Medicaid ranged from change in employment status (74 percent) to change in marital/parental status (14 percent) or missing appointments for determination of benefits (14 percent).

Among those terminated from Medicaid, 78 percent said at least one family member lacked health insurance. Among those without coverage, 73 percent said coverage was too expensive to purchase, 27 percent said their employers did not offer health insurance, and 10 percent either did not want coverage or were turned down for medical reasons.

Uninsured participants also were asked how much they could pay to purchase health insurance. Only 11 percent indicated that they could pay $200 a month or more for coverage, and even at $50 a month, only 57 percent said they could buy insurance.

Eric Campbell, PhD, of the MGH and HMS, a study co-author, notes that the least expensive insurance available to nongroup subscribers in Massachusetts at the time of the study cost $350 a month for family coverage. "There appears to be a serious discrepancy between how much insurance costs and how much low-income people can pay."

Among both groups of respondents those still covered by Medicaid and those terminated more than 90 percent indicated they had a regular source for medical care, and 86 percent of the uninsured with a regular source of care said it was the same source they used before termination. Uninsured patients,however, reported significantly more difficulty in obtaining health care services than did those with some source of coverage. Among those with serious health problems, people who lost Medicaid were three times as likely as those still covered to report difficulty getting needed care for those problems. Overall, those without Medicaid were nine times as likely to say they could not get prescriptions filled and three times as likely to say they went without medical care because it was too expensive.

Robert Witzburg, MD, vice chairman of Medicine at Boston Medical Center and a co-author of the study, says, "While we were pleased to see how many of the uninsured continued relationships with their providers, we were very concerned about the numbers reporting problems with access to care. Loss of Medicaid coverage could lead to serious health conse-quences if people delay or forego needed services."

Follow up studies, the researchers say, should look at larger populations in Massachusetts and elsewhere to see whether those who lose Medicaid coverage through other providers have similar experiences and, if so, what the long-terms effects are on their health and that of their children.

Massachusetts General Hospital

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