Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2009 Jan;24(1):1-7.
doi: 10.1007/s11606-008-0792-9. Epub 2008 Sep 23.

Loss of health insurance among non-elderly adults in Medicaid

Benjamin D Sommers  1
Affiliations
Comparative Study

Loss of health insurance among non-elderly adults in Medicaid

Benjamin D Sommers. J Gen Intern Med. 2009 Jan.

Abstract

Background: Major policy efforts to expand health coverage to the uninsured are under consideration. Drop-out among children in Medicaid--due to annual renewal requirements--is well-documented, but the recent extent of this problem among non-elderly adults is unknown.

Objective: To estimate the loss of health insurance over time among adults in Medicaid and identify risk factors for drop-out.

Design: Survival analysis of Medicaid enrollment, using Kaplan-Meier curves and Cox proportional-hazards regression. Data are from the nationally representative Medical Expenditure Panel Survey, 2000-2004. The sample consists of non-elderly adults (n = 4,992) and children (n = 8,559) in Medicaid. Insurance status after 12 months was measured for all individuals enrolled in Medicaid at the survey's outset. A survival analysis of disenrollment was then conducted for newly enrolled individuals.

Results: Nationwide, 2 million adults leave Medicaid and become uninsured annually. Disenrollment was significantly higher among adults than children (hazard ratio 1.75, 95% CI 1.65-1.86). Respectively, 20%, 43%, and 55% of adults disenrolled within 6, 12, and 23 months of initial enrollment. Lost eligibility explained a small portion of disenrollment. Six months after disenrolling, 17% had reenrolled in Medicaid, 34% had other insurance, and 49% were uninsured. Men, younger adults, and Hispanics were more likely to drop out; those in Medicaid managed care or with disabilities were less likely. Overall health status and diseases, such as diabetes, heart disease, and depression, had no effect on drop-out.

Conclusions: Drop-out from Medicaid is a major problem among adults--even among those with chronic diseases--and contributes to the presence of millions of uninsured Americans. Policy efforts to expand health coverage must address poor Medicaid retention. Clinicians should be aware of this issue when caring for non-elderly adults in Medicaid.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Kaplan-Meier curves for disenrollment from Medicaid: Panel A: stratified by age — children and adults; Panel B: adults stratified by eligibility — ‘always eligible’ and others.
See this image and copyright information in PMC

Comment in

References

    1. None
    2. DeNavas-Walt C, Proctor BD, Smith J. U.S. Census Bureau, Current Population Reports, P60-233. Income, poverty, and health insurance coverage in the United States: 2006. Washington, DC: U.S. Government Printing Office; 2007.
    1. None
    2. Burton A, Friedenzohn I, Martinez-Vidal E. State strategies to expand health insurance coverage: Trends and lessons for policymakers. New York: Commonwealth Fund; 2007.
    1. None
    2. Collins SR, Schoen C, Davis K, Gauthier AK, Schoenbaum SC. A roadmap to health insurance for all: Principles for reform. New York: Commonwealth Fund; 2007.
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1377/hlthaff.23.5.39', 'is_inner': False, 'url': 'https://doi.org/10.1377/hlthaff.23.5.39'}, {'type': 'PubMed', 'value': '15371369', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/15371369/'}]}
    2. Selden T, Hudson J, Banthin J. Tracking changes in eligibility and coverage among children, 1996–2002. Health aff. 2004;23:39–49. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1111/j.1475-6773.2005.00342.x', 'is_inner': False, 'url': 'https://doi.org/10.1111/j.1475-6773.2005.00342.x'}, {'type': 'PMC', 'value': 'PMC1361126', 'is_inner': False, 'url': 'https://pmc.ncbi.nlm.nih.gov/articles/PMC1361126/'}, {'type': 'PubMed', 'value': '15663702', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/15663702/'}]}
    2. Sommers BD. From Medicaid to uninsured: drop-out among children in public insurance programs. Health Serv Res. 2005;40:59–78. - PMC - PubMed

Publication types

MeSH terms