Disasters and the public health safety net: Hurricane Floyd hits the North Carolina Medicaid program

Abstract

Objectives: We measured the effect of Hurricane Floyd on Medicaid enrollment and health services use in the most severely affected counties of North Carolina.

Methods: We used differences-in-differences models on balanced panels of Medicaid claims and enrollment data.

Results: Overall spending per enrollee showed little short-term effect but demonstrated a moderate increase 1 year after the storm. We found very modest short-term increases in Medicaid enrollment, a small long-term decrease in enrollment, and large increases in the long-term use of emergency room and outpatient services.

Conclusions: Our findings suggest that hurricane victims experienced substantial changes in patterns of care that endured for much longer than the initial crisis period. These findings can have important implications for the management of disaster relief for this population.

FIGURE 1—

Map of North Carolina showing counties that experienced moderate or severe damage from Hurricane Floyd in September 1999.

FIGURE 2—

Average spending per Medicaid enrollee before and after Hurricane Floyd in severely affected, moderately or minimally affected, and unaffected counties of North Carolina.