{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T04:08:57Z","timestamp":1775016537824,"version":"3.50.1"},"reference-count":24,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Medicaid coverage loss can substantially compromise access to and affordability of health care for dual-eligible beneficiaries. The extent to which this population lost Medicaid coverage before and during the COVID-19 public health emergency (PHE) and the characteristics of beneficiaries more at risk for coverage loss are currently not well known.<\/jats:p><\/jats:sec>Objective<\/jats:title>To assess the loss of Medicaid coverage among dual-eligible beneficiaries before and during the first year of the PHE, and to examine beneficiary-level and plan-level factors associated with heightened likelihood of losing Medicaid.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This repeated cross-sectional study used national Medicare data to estimate annual rates of Medicaid loss among dual-eligible beneficiaries before (2015 to 2019) and during the PHE (2020). Individuals who were dual eligible for Medicare and Medicaid at the beginning of a given year and who continuously received low-income subsidies for Medicare Part D prescription drug coverage were included in the sample. Multivariable regression models were used to examine beneficiary-level and plan-level factors associated with Medicaid loss. Data analyses were conducted between March 2023 and October 2023.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Onset of PHE.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Loss of Medicaid for at least 1 month within a year.<\/jats:p><\/jats:sec>Results<\/jats:title>Sample included 56\u202f172\u202f736 dual-eligible beneficiary-years between 2015 and 2020. In 2020, most dual-eligible beneficiaries were aged over 65 years (5\u202f984\u202f420 [61.1%]), female (5\u202f868\u202f866 [59.9%]), non-Hispanic White (4\u202f928\u202f035 [50.3%]), full-benefit eligible (6\u202f837\u202f815 [69.8%]), and enrolled in traditional Medicare (5\u202f343\u202f537 [54.6%]). The adjusted proportion of dual-eligible beneficiaries losing Medicaid for at least 1 month increased from 6.6% in 2015 to 7.3% in 2019 and then dropped to 2.3% in 2020. Between 2015 and 2019, dual-eligible beneficiaries who were older (ages 55-64 years: \u22121.4%; 95% CI, \u22121.8% to \u22121.0%; ages 65-74 years: \u22122.0%; 95% CI, \u22122.5% to \u22121.5%; ages 75 and older: \u22124.5%; 95% CI, \u22125.0% to \u22124.0%), disabled (\u22120.8%; 95% CI, \u22121.1% to \u22120.6%), and in integrated care programs were less likely to lose Medicaid. In 2020, the disparities within each of these demographic groups narrowed significantly. Notably, while Black (0.6%; 95% CI, 0.2% to 0.9%) and Hispanic (0.7%; 95% CI, 0.3% to 1.2%) dual-eligible beneficiaries were more likely to lose Medicaid than their non-Hispanic White counterparts between 2015 and 2019, such gap was eliminated for Black beneficiaries and narrowed for Hispanic beneficiaries in 2020.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>During the PHE, Medicaid coverage loss declined significantly among dual-eligible beneficiaries, and disparities were mitigated across subgroups. As the PHE unwinds, it is crucial for policymakers to implement strategies to minimize Medicaid coverage disruptions and racial and ethnic disparities, especially given that loss of Medicaid was slightly increasing over time before the PHE.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.5876","type":"journal-article","created":{"date-parts":[[2024,4,11]],"date-time":"2024-04-11T15:00:55Z","timestamp":1712847655000},"page":"e245876","source":"Crossref","is-referenced-by-count":10,"title":["Medicaid Eligibility Loss Among Dual-Eligible Beneficiaries Before and During COVID-19 Public Health Emergency"],"prefix":"10.1001","volume":"7","author":[{"given":"Yanlei","family":"Ma","sequence":"first","affiliation":[{"name":"Department of Health Policy & Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric T.","family":"Roberts","sequence":"additional","affiliation":[{"name":"University of Pennsylvania, Philadelphia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenton J.","family":"Johnston","sequence":"additional","affiliation":[{"name":"Washington University in St Louis, St Louis, Missouri"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E. John","family":"Orav","sequence":"additional","affiliation":[{"name":"Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose F.","family":"Figueroa","sequence":"additional","affiliation":[{"name":"Department of Health Policy & Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts"},{"name":"Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10","published-online":{"date-parts":[[2024,4,11]]},"reference":[{"issue":"7","key":"zoi240240r3","doi-asserted-by":"publisher","first-page":"1153","DOI":"10.1377\/hlthaff.2018.05165","article-title":"Association of state policies with Medicaid disenrollment among low-income Medicare beneficiaries.","volume":"38","author":"Roberts","year":"2019","journal-title":"Health Aff (Millwood)"},{"issue":"1","key":"zoi240240r4","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1377\/hlthaff.2013.0396","article-title":"Understanding factors associated with loss of Medicaid coverage among dual eligibles can help identify vulnerable enrollees.","volume":"33","author":"Riley","year":"2014","journal-title":"Health Aff (Millwood)"},{"issue":"4","key":"zoi240240r7","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1377\/hlthaff.2018.05032","article-title":"The role of social, cognitive, and functional risk factors in Medicare spending for dual and nondual enrollees.","volume":"38","author":"Johnston","year":"2019","journal-title":"Health Aff (Millwood)"},{"issue":"6","key":"zoi240240r8","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1001\/jamainternmed.2023.0512","article-title":"Racial and ethnic disparities in health care use and access associated with loss of Medicaid supplemental insurance eligibility above the federal poverty level.","volume":"183","author":"Roberts","year":"2023","journal-title":"JAMA Intern Med"},{"issue":"1","key":"zoi240240r15","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1007\/s10903-021-01178-8","article-title":"Medicaid redetermination and renewal experiences of limited English proficient beneficiaries in Illinois.","volume":"24","author":"Mirza","year":"2022","journal-title":"J Immigr Minor Health"},{"issue":"5","key":"zoi240240r19","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1377\/hlthaff.2022.01321","article-title":"Enrollment and characteristics of dual-eligible Medicare and Medicaid beneficiaries in integrated care programs.","volume":"42","author":"Velasquez","year":"2023","journal-title":"Health Aff (Millwood)"},{"key":"zoi240240r21","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.18834","article-title":"Older adults and people with disabilities are at disproportionate risk for Medicaid procedural disenrollment.","author":"Tjhia","year":"2023","journal-title":"J Am Geriatr Soc"},{"key":"zoi240240r1","unstructured":"Kaiser Family Foundation. Number of Medicare-Medicaid Enrollees Based on Medicare Claims Data. Kaiser Family Foundation. Accessed March 30, 2023. https:\/\/www.kff.org\/other\/state-indicator\/number-of-medicare-medicaid-enrollees-based-on-medicare-claims-data\/"},{"key":"zoi240240r2","unstructured":"Feng? Z, Vadnais? A, Vreeland? E, . Loss of Medicare-Medicaid Dual Eligible Status: Frequency, Contributing Factors and Implications. US Department of Health and Human Services Assistant Secretary for Planning and Evaluation Office of Disability, Aging and Long-Term Care Policy. May 2019. Accessed October 27, 2023. https:\/\/aspe.hhs.gov\/sites\/default\/files\/migrated_legacy_files\/\/189201\/DualLoss.pdf"},{"key":"zoi240240r5","unstructured":"Medicaid; Children\u2019s Health Insurance Program; Coverage Learning Collaborative. Medicaid and CHIP Renewals and Redeterminations. January 13, 2021. 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Unwinding the Medicaid Continuous Enrollment Provision: Projected Enrollment Effects and Policy Approaches. Office of the Assistant Secretary for Planning and Evaluation. August 19, 2022. Accessed September 14, 2023. https:\/\/aspe.hhs.gov\/sites\/default\/files\/documents\/404a7572048090ec1259d216f3fd617e\/aspe-end-mcaid-continuous-coverage_IB.pdf"},{"key":"zoi240240r11","unstructured":"Consolidated Appropriations Act of 2023, HR 2617, 117th Congress (2022). H Prt No. 117-73. Accessed September 14, 2023. https:\/\/www.congress.gov\/bill\/117th-congress\/house-bill\/2617\/text"},{"key":"zoi240240r12","unstructured":"Tolbert? J, Ammula? M. 10 Things to Know About the Unwinding of the Medicaid Continuous Enrollment Provision. Kaiser Family Foundation. June 9, 2023. Accessed September 14, 2023. https:\/\/www.kff.org\/medicaid\/issue-brief\/10-things-to-know-about-the-unwinding-of-the-medicaid-continuous-enrollment-provision\/"},{"key":"zoi240240r13","unstructured":"Lakhmani? EW, Lomas? A, Wood? E. Preventing and Addressing Unnecessary Medicaid Eligibility Churn Among Dually Eligible Individuals: Opportunities for States. Integrated Care Resource Center. March 2022. Accessed September 14, 2023. https:\/\/www.integratedcareresourcecenter.com\/sites\/default\/files\/\u20acCRC_Addressing_Medicaid_Churn.pdf"},{"key":"zoi240240r14","unstructured":"Research Data Assistance Center. Research Triangle Institute (RTI) Race Code. Accessed January 31, 2024. https:\/\/resdac.org\/cms-data\/variables\/research-triangle-institute-rti-race-code"},{"key":"zoi240240r16","unstructured":"Haldar? S, Artiga? S, Rudowitz? R, Damico? A. Unwinding of the PHE: Maintaining Medicaid for People with Limited English Proficiency. Kaiser Family Foundation. March 3, 2022. Accessed September 14, 2023. https:\/\/www.kff.org\/medicaid\/issue-brief\/unwinding-of-the-phe-maintaining-medicaid-for-people-with-limited-english-proficiency\/"},{"key":"zoi240240r17","unstructured":"Artiga? S, Pham? O. Recent Medicaid\/CHIP Enrollment Declines and Barriers to Maintaining Coverage. Kaiser Family Foundation. September 24, 2019. Accessed September 14, 2023. https:\/\/www.kff.org\/medicaid\/issue-brief\/recent-medicaid-chip-enrollment-declines-and-barriers-to-maintaining-coverage\/"},{"key":"zoi240240r18","unstructured":"Wikle? S, Wagner? J, Erzouki? F, Sullivan? J. States Can Reduce Medicaid\u2019s Administrative Burdens to Advance Health and Racial Equity. Center on Budget and Policy Priorities. July 19, 2022. Accessed September 14, 2023. https:\/\/www.cbpp.org\/research\/health\/states-can-reduce-medicaids-administrative-burdens-to-advance-health-and-racial"},{"key":"zoi240240r20","unstructured":"Burns? A, Williams? E, Corallo? B, Rudowitz? R. How Many People Might Lose Medicaid When States Unwind Continuous Enrollment? Kaiser Family Foundation. April 26, 2023. 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Accessed September 25, 2023. https:\/\/www.kff.org\/medicaid\/issue-brief\/a-50-state-review-of-access-to-state-medicaid-program-information-for-people-with-limited-english-proficiency-and-or-disabilities-ahead-of-the-phe-unwinding\/"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2817442\/ma_2024_oi_240240_1712178323.33845.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,11]],"date-time":"2024-04-11T15:01:03Z","timestamp":1712847663000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2817442"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,11]]},"references-count":24,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,4,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2024.5876","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,11]]}}}