Abstract
Substantial studies have been conducted on Medicaid program enrollment; however, less is known about the termination of enrollees, also referred to as disenrollment. Although Medicaid eligibility expanded under the Patient Protection and Affordable Care Act (ACA) in 2014, many enrollees continue to face coverage termination despite remaining eligible. This study addresses a significant gap in the literature regarding the determinants of Medicaid benefit loss among eligible nonelderly (aged <65 years) enrollees across all U.S. states and Washington, D.C., with a focus on identifying effective mitigation strategies for re-enrollment.
This study's conceptual framework is based on Herd and Moynihan's (2018) Administrative Burden Theory (ABT) and incorporates Coase's (1937) and Williamson's (1975, 1985) Transaction Cost Theory (TCT).
We employ the qualitative comparative analysis (QCA) method, which is designed to identify the combinations of factors that drive Medicaid re-enrollment outcomes across states. This set-theoretic configurational approach employs the logic of Boolean algebra to examine the necessary and sufficient conditions for better outcomes.
I find that improved ex parte renewal strategies, such as renewals for individuals based on Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF) eligibility information, and an augmentation of efforts, including extending the timeframe for final administrative action on fair hearing requests and delaying the resumption of Medicaid premiums, along with clear reasons for coverage loss presented on the states’ websites, and Democratic partisan state control over Medicaid policy, all contribute to increased renewal rates.
The study found that inclusive policies, Democratic Party politics, and implementation design enhance Medicaid renewal rates. It recommends that CMS and state Medicaid agencies develop a uniform, technology-enhanced asset verification strategy that utilizes electronic data sources to streamline and automate asset inspections during eligibility renewals. Additionally, it suggests automatically renewing eligibility for enrollees with stable or no income (e.g., those at or below 100% FPL, with zero income, or with Social Security income) and using enrollment information from other means-tested programs like TANF and SNAP to confirm Medicaid eligibility without verification in all 50 states and DC.