States can address Medicaid inequity by promoting continuity of coverage, study finds
Making it easier for eligible people to enroll in and maintain Medicaid coverage also may help close coverage gaps for people of color.
Medicaid has helped level the health care playing field for people of color, especially during the pandemic. Promoting continuity of coverage as states unwind the Medicaid continuous enrollment provision can continue to help mitigate disparities in coverage and care, according to a new report from KFF.
The Families First Coronavirus Response Act included a temporary requirement that Medicaid programs keep people continuously enrolled in the exchange for enhanced federal funding. However, this provision ended in March, and states will need to conduct redeterminations for all Medicaid enrollees during the next 12 to 14 months. An estimated 17 million people could lose Medicaid coverage, and research shows that Hispanic and black people are likely to be disproportionately affected.
The end of this provision may increase “churn,” the temporary loss of Medicaid coverage in which enrollees unenroll and then re-enroll within a short period of time. A recent analysis found that although churn rates increased among children of all racial and ethnic groups following annual renewal, the increase was largest for Hispanic children, suggesting they face greater barriers to maintaining coverage.
State policies to promote continuity of coverage during the ending of the continuous enrollment provision could help mitigate coverage losses, but redeterminations for all enrollees will pose a major operational challenge because of state staffing shortages and enrollment systems issues. State efforts to provide outreach, simplify Medicaid renewal processes and provide assistance to help individuals transition to other coverage or complete renewal processes will affect coverage losses and potential impacts on coverage disparities.
Adoption of the Affordable Care Act’s Medicaid expansion in the 10 non-expansion states also could help close coverage disparities for people of color. In these states, 1.9 million people fall in a coverage gap, with incomes too high to qualify for Medicaid but too low to qualify for Marketplace subsidies. Nationally, more than 6 in 10 individuals in the coverage gap are people of color.
Making it easier for eligible people to enroll in and maintain Medicaid coverage also may help close coverage gaps for people of color. Sustained outreach and enrollment efforts through trusted members in the community are key for facilitating enrollment of certain populations, including immigrants and people with limited English proficiency, who may face added barriers to enrollment.
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“Looking ahead, a number of actions at the state and federal levels could further advance racial health equity,” the report concluded. “These include actions to prevent widening coverage disparities with the end of the Medicaid continuous enrollment requirement and to further narrow coverage disparities through other Medicaid coverage expansions. In addition, improving data collection and reporting practices, and creating incentives and requirements tied to equity can help to address disparities.”