California’s requirement that Medi-Cal patients renew every three months caused 62% to have periods of no health care. People experiencing this gap were over three times as likely to be hospitalized for unnecessary complications of diabetes, asthma, and hypertension, usually within three months of loosing coverage. Most eventually regained coverage, but suffered diabetic complications, chronic obstructive pulmonary disease and heart failure in the meantime. Permanently re-imposing the 3 month re-registration, as proposed, would deprive 470,000 Californians of Medi-Cal over 3 years. How long are we willing to let this murderous system remain in place? (Dec. 17, 2008)
New York Times, Dec 17, 2008
By RONI CARYN RABIN
People who have spotty Medicaid coverage are more than three times likelier than those who maintain continuous coverage to be hospitalized for an illness that could have been managed outside the hospital with doctors’ visits and medication, a five-year retrospective study of almost 5 million California residents has found.
Medicaid is the federal program administered by states that reimburses health providers for care for low-income patients. The study calls into question the practice of having Medicaid recipients re-qualify every few months for benefits, experts said, suggesting that constant re-qualifications may be more costly in the end.
The study was published on Tuesday in the Annals of Internal Medicine.
Some 62 percent of Medicaid recipients experienced a gap in coverage during the course of the study, and these beneficiaries were 3.6 times more likely to be hospitalized for chronic conditions like diabetes, asthma and high blood pressure, the researchers found. Heart failure, diabetes and chronic obstructive pulmonary disease were the leading causes of hospitalizations among the Medicaid recipients, who were studied from 1998 to 2002.
Most were admitted to the hospital within three months of losing coverage; once in the hospital, most were able to qualify again for Medicaid, according to the study.
“We’re not saying these hospitalizations would never have occurred, but when you have better access to primary care services, you’re able to avoid a lot of these hospitalizations,” said Dr. Andrew Bindman, lead author of the study and a professor of medicine at the University of California, San Francisco.
Medicaid recipients often are required to re-qualify for the program periodically, Dr. Bindman said. If they fail to provide all the documentation required, they lose access to reimbursement for all health care, including doctors’ visits and drug coverage.
“You lose your coverage, so you don’t get your medications refilled, and within those few weeks to months your health declines and you get hospitalized,” Dr. Bindman said. “What we find is that many patients, faced with financial barriers to getting care, wait and wait, hoping it’s going to go away, and by the time they come to the emergency department, the game is over and the only recourse is hospitalization.”
During most of the study period, Medicaid recipients in California were required to report on eligibility every three months, the researchers said, but that practice has since changed.
Medicaid requires frequent eligibility checks in order to prevent waste and fraud, Dr. Bindman said. Cutting off coverage for those who cannot document eligibility may save money in the short run, but this study “brings home the fact that in many ways, Medicaid ends up paying for these patients in the long run, and doing it in a more expensive setting than would have been the case if they had maintained the coverage.”
Mary Kahn, a spokeswoman for federal Centers for Medicare and Medicaid Services, which oversees the Medicaid program, said recertification requirements, including the frequency of recertification, are set at the state level. The federal government requires recertification just once a year, she said.
“It certainly does not come as a surprise that people who routinely lose access to medical care would suffer health consequences,” Ms. Kahn said. “This is not strictly a situation with Medicaid — people who lose private health insurance when they lose a job or age out of coverage often don’t seek care until their illness is critical.”