February 21, 2024
New OCHIN-led research found that the conclusion of a temporary Medicaid continuous coverage policy, enacted at the start of the COVID-19 pandemic, impacted the health care coverage of adults receiving care in the OCHIN network. In addition, a newly awarded grant from the Robert Wood Johnson Foundation (RWJF) is funding additional research to explore how the policy change has impacted children and the OCHIN member health centers caring for them.
At the same time that national data is tracking the number of children and adults losing Medicaid coverage nationwide, OCHIN researchers are focusing on the impact on OCHIN network patients and the community health centers that provide essential primary care for rural and medically underserved communities.
Ensuring primary care access
“We know from our members’ experience, and broader research, how important insurance coverage is for primary care access and utilization,” said Wyatt Bensken, PhD, an OCHIN research investigator and lead author of the research letter.
“We found that a substantial number of patients who receive care from OCHIN member health centers lost Medicaid coverage during the unwinding of continuous Medicaid coverage. Through this research, we are continuing to advance our understanding of the impact of Medicaid unwinding on children and on the community health centers that provide care for them.”
As part of the Families First Coronavirus Response Act (FFCRA), federal legislation enacted in April 2020 in response to the pandemic, states were required to provide continuous Medicaid coverage to people who were enrolled. In exchange, states received additional federal funding. However, continuous enrollment ended on March 31, 2023, and states could disenroll people from Medicaid using their pre-pandemic, standard annual eligibility procedures. This resulted in an estimated 16.9+ million people losing coverage nationwide.
“Loss of continuous Medicaid coverage occurring with the unwinding of states’ incentives to provide that coverage can be devastating not only to individual patients needing care, but also to the community health centers that provide care,” said Scott Fields, MD, MHA, OCHIN senior clinical advisor and family physician. “It also exacerbates health disparities for medically underserved communities.”
A disparate coverage impact for patients
In the research letter published in JAMA Health Forum, Bensken, along with co-investigators from OCHIN and their partners, used electronic health record data from the OCHIN-led ADVANCE Clinical Research Network funded through the Patient Centered Outcomes Research Institute (PCORI). The cohort included adult patients with an in-person or telehealth visit at 1,114 OCHIN Epic member health centers in 28 states, both during the continuous enrollment period and then after the provision ended. The researchers highlighted several findings:
- Among the 575,170 patients who had a visit covered by Medicaid during the continuous enrollment period, 96,189 (17%) became uninsured for at least one visit in the six months after the April 2023 termination of continuous enrollment.
- The percentage who transitioned from Medicaid to uninsurance was higher among specific subgroups, including:
- Patients who were younger, Native American and Alaska Native, or Black/African American
- Patients with HIV/AIDS, substance misuse, mental health conditions, or a higher number of visits
Financial impact on health centers
Medicaid reimbursement is the single largest source of revenue for community clinics, providing the funds necessary to improve the health of their communities through fair access to high-quality care. In the OCHIN network, 54% of patients receive their health care coverage through Medicaid, and nearly 19% are uninsured. For many people in rural or medically underserved communities, their community-based clinics are the primary and, in many cases, the only source of medical, behavioral, and social needs support. An increase in uninsured patients is likely to have a financial impact on health centers.
Previous OCHIN network evaluations have demonstrated that Medicaid programs improve the health of communities because they provide reliable access to whole-patient care. OCHIN uses our research learnings to inform our advocacy agenda to drive sustainable payment structures for health centers.
Supporting health policy through research
With new funding from RWJF, the research team will build upon this initial study to understand how the unwinding of continuous Medicaid coverage on children impacts OCHIN members and their patients.
“There is still a pressing need to understand how this is impacting patients’ access to care and our members’ sustainability,” said Bensken. “Conducting this work at OCHIN provides an unparalleled opportunity to leverage the expertise of OCHIN’s research and advocacy teams and produce research findings that can inform OCHIN members and policymakers, in addition to the broader research community.”
Read the full research letter in JAMA Health Forum.
This work was conducted with the Accelerating Data Value Across a National Community Health Center Network (ADVANCE) Clinical Research Network (CRN). ADVANCE is led by OCHIN in partnership with Health Choice Network, Fenway Health, and Oregon Health & Science University. ADVANCE is funded through the Patient-Centered Outcomes Research Institute (PCORI), contract number RI-OCHIN-01-MC.
