Study: Virginia Medicaid expansion increased financial security for enrollees
State social services workers signed up homeless residents for Medicaid at a resource fair in Richmond in 2018. Enrollment in the program has more than doubled since Medicaid expansion, leading to rising demand for mental health services. (Ned Oliver/ Virginia Mercury)
Chesterfield resident Geneva Gordon was forced to file for bankruptcy after receiving a $21,000 hospital bill for a reconstructive wrist surgery while uninsured. Leaving her previous job left her without insurance, living paycheck to paycheck and constantly worrying about getting sick and adding to her growing medical debt.
Gordon has since enrolled in Medicaid, which she said has helped her tremendously in the three years she’s had it.
“It’s 100% affordable,” Gordon said. “I haven’t really truly been limited on where I can go and who I can see.”
Individuals like Gordon enrolled in Medicaid reported less financial stress and greater security for non-medical expenses such as housing and food, according to new research published this month in the journal Health Affairs.
The study focuses on people who were eligible for program enrollment following Virginia’s Medicaid expansion in 2019. Nearly 675,000 adults have enrolled in the state’s program since 2019, when Virginia lawmakers voted, after years of Republican opposition, to expand eligibility by increasing the income threshold to 138% of the federal poverty level and allowing individuals without children.
Hannah Shadowen, a medical student at Virginia Commonwealth University who is pursuing a Ph.D., is the lead author of the study. The research team also included the Virginia Department of Medical Assistance Services.
As part of the five-year project, a baseline survey was sent to individuals newly eligible for Medicaid in 2019 to understand their health care experience and financial situation in the year prior to enrollment. Follow-up surveys were sent out in 2020-21. The research team collected over 3,000 responses in total.
Respondents were about one-third less likely to be concerned about normal health care costs compared to prior to enrollment and a quarter less likely to be concerned about catastrophic health care costs.
Gordon said she can now easily afford groceries and household items, as well as gas and car payments. She has also been able to pay off all of her medical debt.
“I don’t have to worry about what I have to do without until I can afford it again,” Gordon said.
The reported changes in financial security following Medicaid enrollment were broadly similar across demographic subgroups, with a few exceptions, Shadowen said.
African American respondents were found to have a greater decrease in concern about paying for housing costs compared to White enrollees. Rural enrollees also reported a greater decrease in concern over paying medical bills compared to non-enrollees.
“It’s also really important to recognize that Medicaid and public health insurance can be a tool for health equity,” Shadowen said.
Annual eligibility reviews of people on Medicaid were suspended in Virginia after the federal government declared a public health emergency in March 2020 as part of COVID-19 relief legislation. State officials predict up to 400,000 people could lose coverage once the reviews resume as a result of Medicaid agencies determining their annual income now exceeds the limit required for eligibility.
Gordon is concerned she’ll lose coverage, as she recently got a new job where her salary slightly exceeds the $18,075 income threshold for one person. If she is disenrolled, Gordon said she would probably have to pay an outrageous amount to get insurance.
“It is not a livable wage on its own,” Gordon said. “But throw in insurance and it’s 100% unaffordable.”
The federal public health emergency was renewed on July 15 for another 90 days. If it isn’t renewed again in October, Virginia could then start the process of disenrolling people.
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