Department of Medicine, Center for Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA.
Stanford University School of Medicine, Stanford, CA.
Medicine (Baltimore). 2022 Dec 30;101(52):e32487. doi: 10.1097/MD.0000000000032487.
The coronavirus disease 2019 public health emergency (PHE) caused extensive job loss and loss of employer-sponsored insurance. State Medicaid programs experienced a related increase in enrollment during the PHE. However, the composition of enrollment and enrollee changes during the pandemic is unknown. This study examined changes in Medicaid enrollment and population characteristics during the PHE. A retrospective study documenting changes in Medicaid new enrollment and disenrollment, and enrollee characteristics between March and October 2020 compared to the same time in 2019 using full-state Medicaid populations from 6 states of a wide geographical region. The primary outcomes were Medicaid enrollment and disenrollment during the PHE. New enrollment included persons enrolled in Medicaid between March and October 2020 who were not enrolled in January or February, 2020. Disenrollment included persons who were enrolled in March of 2020 but not enrolled in October 2020. The study included 8.50 million Medicaid enrollees in 2020 and 8.46 million in 2019. Overall, enrollment increased by 13.0% (1.19 million) in the selected states during the PHE compared to 2019. New enrollment accounted for 24.9% of the relative increase, while the remaining 75.1% was due to disenrollment. A larger proportion of new enrollment in 2020 was among adults aged 27 to 44 (28.3% vs 23.6%), Hispanics (34.3% vs 32.5%) and in the financial needy (44.0% vs 39.0%) category compared to 2019. Disenrollment included a larger proportion of older adults (26.1% vs 8.1%) and non-Hispanics (70.3% vs 66.4%) than in 2019. Medicaid enrollment grew considerably during the PHE, and most enrollment growth was attributed to decreases in disenrollment rather than increases in new enrollment. Our results highlight the impact of coronavirus disease 2019 on state health programs and can guide federal and state budgetary planning once the PHE ends.
2019 年冠状病毒病公共卫生紧急事件（PHE）导致大量失业和雇主赞助保险的丧失。PHE 期间，州医疗补助计划的参保人数有所增加。然而，大流行期间参保人数的构成和参保人变化尚不清楚。本研究调查了 PHE 期间医疗补助参保人数的变化和人口特征。一项回顾性研究记录了 2020 年 3 月至 10 月期间与 2019 年同期相比，6 个地理位置广泛的州的全州医疗补助人群中新参保和退保人数以及参保人特征的变化。主要结果是 PHE 期间的医疗补助参保和退保情况。新参保包括 2020 年 3 月至 10 月期间参保但 2020 年 1 月或 2 月未参保的人员。退保包括 2020 年 3 月参保但 2020 年 10 月未参保的人员。该研究纳入了 2020 年和 2019 年分别为 850 万和 8460 万的医疗补助参保者。总体而言，与 2019 年相比，所选州在 PHE 期间参保人数增加了 13.0%（119 万）。新参保占相对增长的 24.9%，其余 75.1%归因于退保。与 2019 年相比，2020 年新参保者中 27 至 44 岁的成年人（28.3%对 23.6%）、西班牙裔（34.3%对 32.5%）和经济困难人群（44.0%对 39.0%）的比例更高。与 2019 年相比，退保者中老年人（26.1%对 8.1%）和非西班牙裔（70.3%对 66.4%）的比例更高。PHE 期间医疗补助参保人数大幅增加，参保人数的增长主要归因于退保人数的减少，而不是新参保人数的增加。我们的研究结果突出了 2019 年冠状病毒病对州卫生计划的影响，并可以指导联邦和州预算计划在 PHE 结束后进行。
