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Interruptions in Medicaid Increase Risk of Hospitalization

Interruptions in health insurance coverage are common in the United States. For people covered by a public insurance program like Medicaid, the myriad state rules governing eligibility for coverage are partly to blame: to continue qualifying for benefits, Medicaid beneficiaries must demonstrate eligibility each year and, in some states, as often as every three months. These requirements can make people especially vulnerable to disruptions in coverage—and less likely to get regular primary and preventive care.

In a new study published in the Annals of Internal Medicine, researchers led by Andrew Bindman, M.D., of the University of California, San Francisco, found that adult California Medicaid beneficiaries who experienced interruptions in their benefits had a substantially higher risk of hospitalization for ambulatory care-sensitive conditions than did patients with continuous coverage. These conditions include asthma, congestive heart failure, chronic obstructive pulmonary disease, diabetes, and pneumonia.

While Medicaid and other public programs provide coverage to people who would otherwise not have any, the administrative burdens they often place on beneficiaries can impede success in reaching those in need. Policies that reduce the frequency of coverage interruptions, the authors say, could prevent hospitalizations and other events that trigger negative health consequences and high costs.

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"Although states may attempt to save money in the short term by dropping Medicaid coverage for those who cannot keep up with frequent reporting requirements, this study shows that disruptions in coverage come at the risk of increased hospitalization for conditions that can typically be treated in a less expensive primary care setting," said Bindman.

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