Short-term impacts of coverage loss in a Medicaid population: Early results from a prospective cohort study of the Oregon Health Plan

PURPOSE Medicaid programs in all 50 states recently implemented cost-saving strategies, including benefit reductions, cost sharing, and tightened administrative rules. These changes resulted in loss of insurance coverage for thousands of low-income adults nationwide. In this study we assessed the immediate impacts of disrupted and lost Medicaid coverage on adults enrolled in the Oregon Health Plan (OHP) when program changes were implemented. METHODS Data come from baseline survey results of a prospective cohort study designed to assess the impacts of OHP changes on adult beneficiaries. We used bivariate and multivariate analyses to examine the effects of disrupted and lost insurance coverage on unmet health care needs, utilization, and medical debt occurring in the first 10 months after OHP changes were implemented. RESULTS After OHP changes were implemented, 31% of enrolled adults reported losing coverage, and another 15% reported disrupted coverage. Controlling for demographic characteristics, income, and health status, those with disrupted coverage were less likely to have a primary care visit (odds ratio [OR] = .66; P < .05) and more likely to report unmet health care needs (OR = 1.85; P < .01) and medical debt (OR = 1.99; P < .01) when compared with those continuously insured. Those who lost coverage were less likely to have a primary care visit (OR = 0.18; P < .01) and more likely to report unmet health care needs (OR = 5.55; P < .01), unmet medication needs (OR = 2.05; P < 01), and medical debt (OR 3.06; P < .01) than those continuously insured. CONCLUSIONS Medicaid program changes that increase cost sharing and limit enrollment have significant negative impacts on health care access and utilization among Medicaid beneficiaries; these impacts occur rapidly, within the first 10 months after changes.