Who is at risk of Medicaid coverage disruption

Loss of coverage may lead to negative outcomes. A report scrutinizes who is likely to suffer coverage disruption and what the costs of it are.

Continuous health coverage is an important way to ensure better health outcomes for children and young adults. Even short delays in resuming coverage can be linked to fewer preventive health care visits and more utilization of costly health care services like the emergency department. Understanding who is at risk of disrupted Medicaid coverage is key, as is understanding how much an intervention to prevent disenrollment might cost. A recent study provides insight into who is affected.1

Investigators used North Carolina Medicaid claims data to perform a retrospective cohort study. Enrolled participants were age 1 to 20 years on January 1, 2016, and had 30 days of prior continuous enrollment. They were observed for 2 years. The risk of coverage disruptions of 1 to less than 12 months was assessed. Among those who had been disenrolled for 30 or more days, the investigators also examined the risk of reenrollment within 1 to 6 months and 7 to 11 months.

There were 831,173 people in the study who benefited from Medicaid aged 1 to 5 years (23%), 6 to 17 years (68%), and 18 to 20 years (9%). Among the 214,401 people who had a first disenrollment, the risk of reenrollment within 6 months and 7 to 11 months was 19% and 7%, respectively. In comparison to White children, the risk of disrupted coverage was higher for Black children (hazard ratio [HR], 1.21; 95% CI, 1.18-1.24), children of other races (Asian, American Indian, Hawaiian or Pacific Islander, multiple races, or unreported; HR, 1.37; 95% CI, 1.33-1.40), and Latinx children (HR, 1.65; 95% CI, 1.60-1.70). Children with higher medical complexity also had a higher risk of coverage disruption (HR, 1.15; 95% CI, 1.12-1.19).

Counties with the highest unemployment rates had lower risks of coverage disruption (HR, 0.89; 95% CI, 0.85-0.94). The estimated per member per month cost for the entire population in a situation where all medical costs were included was $125.73. In a scenario where disenrollment was prevented it was $122.14.

The investigators concluded that disruption of coverage was high and that children who are members of historically marginalized groups often experience unstable enrollment. Not only could interventions to reduce disenrollment lead to better health outcomes, they could lead to cost reductions for Medicaid programs.


1. Cholera R, Anderson D, Raman S, et al. Medicaid coverage disruptions among children enrolled in North Carolina medicaid from 2016 to 2018. JAMA Health Forum. 2021;2(12):e214283. doi:10.1001/jamahealthforum.2021.4283