Medicaid 'churning' leads to increased acute care use for patients with major depression

July 17, 2017

For adult Medicaid beneficiaries with major depression, disruptions in coverage are followed by increases in emergency department (ED) visits and longer hospital stays after the person goes back on Medicaid, reports a study in the August issue of Medical Care.

Disruptions in Medicaid —sometimes called "churning"—are less frequent in states with streamlined Medicaid re-enrollment procedures (ie, requiring only yearly recertification versus every six or more frequently). According to the report by Xu Ji, MSPH, and colleagues of Rollins School of Public Health, Emory University, "Maintenance of continuous Medicaid coverage may help prevent acute episodes requiring high-cost interventions" for those with mental health problems.

Disruptions in Medicaid Coverage Linked to Increases in Acute Care Use

The study used Medicaid data on nearly 140,000 adults treated for major depression during 2003-04. The researchers looked at how disruptions in Medicaid coverage affected healthcare use—focusing on services such as ED visits and hospital stays.

The results show the high rate of Medicaid "churning" among low-income adults with major depression, and suggests that these disruptions lead to increased use of costly ED and hospital inpatient services among this vulnerable population after they re-enroll in Medicaid. Twenty-nine percent of patients had disruptions in Medicaid coverage lasting at least one month; the average duration was eight months. About one-fourth of patients with interrupted coverage re-enrolled in Medicaid later during the study period.

Medicaid beneficiaries with depression that had interrupted coverage experienced increased use of acute care services. Emergency department visits were about 40 percent higher and hospital stays were about 67 percent longer for those with disruptions in coverage than for those without disruptions. The data used in this study did not include any information on care use or costs during the periods when patients lost Medicaid coverage.

For patients with coverage disruptions, acute care costs increased by $650 per patient per Medicaid-covered month, compared to those without . The increase in acute care costs contributed to an overall increase in costs for all adult patients with : by $310 per person per Medicaid-covered month.

The sharpest rise in acute care costs occurred during the first two months after re-enrolling in Medicaid. The longer the disruption in coverage, the more intensive the use of acute care after re-enrollment.

Disruption in coverage was related to state policies regarding Medicaid re-enrollment. The disruption rate was 25.8 percent among beneficiaries living in states with more streamlined policies (requiring re-enrollment yearly) versus 37.5 percent among those living in states with more frequent re-enrollment (every six months or more frequently).

Ms. Ji and coauthors write, "State policies related to Medicaid re-enrollment have implications for coverage continuity." They add that, "The lack of a constant source of coverage may cause patients to miss visits with their providers until their depression symptoms and complications worsen to the degree that emergency visits are required. For some individuals, acute care may serve as "an entry point for returning to treatment" and "trigger their re-enrollment in Medicaid."

The authors note some significant limitations of their study—particularly the use of older Medicaid data. But they believe the findings still have important implications amid the current debate over Medicaid and the possible repeal of the Affordable Care Act.

The Affordable Care Act streamlines Medicaid re-enrollment policies by requiring states to recertify eligibility no more frequently than annually for beneficiaries who qualify based on income. Proposals currently debated in Congress would give states more autonomy in administrating their Medicaid programs. Some proposals include the option of re-determining eligibility every six months or more frequently. The findings of this study suggest that the proposed policies could exacerbate disruptions in Medicaid coverage for those with mental health needs, which can increase the use of costly services delivered in hospital acute care settings. As policymakers continue to debate the future of Medicaid, it will be important to consider "strategies that improve the continuity of Medicaid coverage and ensure adequate access to care for vulnerable populations."

Explore further: Medicaid expansion states saw ER visits go up, uninsured ER visits go down

More information: Xu Ji et al. Discontinuity of Medicaid Coverage, Medical Care (2017). DOI: 10.1097/MLR.0000000000000751

Related Stories

Medicaid expansion states saw ER visits go up, uninsured ER visits go down

June 19, 2017
States that expanded Medicaid coverage under the Affordable Care Act (the ACA) saw 2.5 emergency department visits more per 1,000 people after 2014, while the share of emergency department visits by the uninsured decreased ...

Kentucky study highlights harms from disruptions in children's Medicaid coverage

May 4, 2017
New research being presented at the 2017 Pediatric Academic Societies Meeting suggest that when children lose state Medicaid coverage even for a short time, they are likely to go without needed health care, or to receive ...

Survey finds Medicaid enrollees satisfied with coverage, physician access

July 10, 2017
Enrollees in Medicaid reported in a nationwide survey that they're largely satisfied with the health care they receive under the program, according to researchers at Harvard T.H. Chan School of Public Health. Most Medicaid ...

Medicaid restrictions linked to increased late-stage breast cancer diagnoses

June 26, 2017
Women in Tennessee who were diagnosed with breast cancer were more likely to be diagnosed with late stage disease after a substantial rollback of Medicaid coverage for adults in the state, according to a new analysis. When ...

Michigan heart surgery outcomes improved after Medicaid expansion, study finds

June 7, 2017
Expanding Medicaid coverage is associated with better outcomes for heart surgery patients, according to a study led by University of Virginia School of Medicine researchers.

The impact of ACA Medicaid expansion on dental visits: mixed results

April 3, 2017
Dental coverage for adults is an optional benefit under Medicaid, one that about half of the states offer. With thirty-one states and the District of Columbia expanding Medicaid eligibility under the Affordable Care Act (ACA), ...

Recommended for you

Breathing dirty air may harm kidneys, study finds

September 21, 2017
Outdoor air pollution has long been linked to major health conditions such as heart disease, stroke, cancer, asthma and chronic obstructive pulmonary disease. A new study now adds kidney disease to the list, according to ...

Excess dietary manganese promotes staph heart infection

September 21, 2017
Too much dietary manganese—an essential trace mineral found in leafy green vegetables, fruits and nuts—promotes infection of the heart by the bacterium Staphylococcus aureus ("staph").

Being active saves lives whether a gym workout, walking to work or washing the floor

September 21, 2017
Physical activity of any kind can prevent heart disease and death, says a large international study involving more than 130,000 people from 17 countries published this week in The Lancet.

Frequent blood donations safe for some, but not all

September 21, 2017
(HealthDay)—Some people may safely donate blood as often as every eight weeks—but that may not be a healthy choice for all, a new study suggests.

Higher manganese levels in children correlate with lower IQ scores, study finds

September 21, 2017
A study led by environmental health researchers at the University of Cincinnati (UC) College of Medicine finds that children in East Liverpool, Ohio with higher levels of Manganese (Mn) had lower IQ scores. The research appears ...

Higher levels of fluoride in pregnant woman linked to lower intelligence in their children

September 20, 2017
Fluoride in the urine of pregnant women shows a correlation with lower measures of intelligence in their children, according to University of Toronto researchers who conducted the first study of its kind and size to examine ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.