Legislature should make sure people who need Medicaid can get it

One of the important lessons we learned living through the COVID-19 pandemic was how critical it was that all of us had access to the care we needed, when we needed it. Having continuous and reliable health insurance, access to well-child visits and early screening, access to medications, mental health care, and many other supports meant many of us could survive through the hardships.

To maintain access to health and mental health services during the pandemic, Minnesota — like other states — complied with federal requirements to keep people enrolled in Medicaid during the public health emergency.  This allowed over 1 million Minnesotans to continue to receive uninterrupted care and supports through Medicaid, or as we call it in Minnesota, Medical Assistance. As a result, new monthly MA applications dropped off dramatically because people who were eligible for MA weren’t being dropped and forced to re-enroll multiple times per year.

Long before the pandemic, people getting care through MA often cycled on and off assistance because of minor and temporary changes in income or eligibility — a cycle referred to as “churn.” Adults and children can experience churn, for example, when a parent earns a bit more in seasonal overtime pay and gets disenrolled in MA, only to have their hours cut and qualify for MA once again. 

People also experience churn when housing instability leads to missed mailings for mid-year information requests. Prior to the COVID pandemic, nationally approximately one in 10 Medicaid participants disenrolled and then re-enrolled within one year. Of those disenrolled and re-enrolled, over 40% re-enrolled within three months. It is a chronic problem that causes costly disruptions to care for Minnesota children and adults, as well as the providers and state agencies that serve them. 

Policymakers have an opportunity to break this harmful cycle, and ensure Minnesotans can get health care through MA by expanding continuous eligibility for 12 months for children and adults, and even longer for children under age 6 by passing HF914/SF531.

Continuous eligibility creates stability for adults, including those with mental illnesses

Adults who go without insurance for portions of the year are far more likely to have unmet medical needs than those with continuous coverage for a year or more. About half of those without continuous coverage had unmet medical needs compared to just 14% of those with continuous coverage. This leads to worse health outcomes.

Even small gaps in coverage can have harmful consequences for those Medicaid recipients with serious mental illness. Medicaid is the largest payer of mental health services, with people with serious mental illnesses depending on it to pay for in-home and community services. Nationally, among the adults who gained coverage through Medicaid expansion under the Affordable Care Act, about 30% have a mental illness or substance use disorder. 

Several factors can disrupt Medicaid coverage for people with serious mental illnesses: Housing instability causes paperwork to be sent to the wrong address; the symptoms of a serious mental illness may make it hard to understand the forms; or the paperwork simply becomes overwhelming. Continuous eligibility would mitigate these barriers to care, ensuring 12 months at a time of stable coverage. 

Another benefit of continuous Medicaid eligibility for adults is the positive repercussions on their children. Research shows that when adults are included in access to health coverage, their children are more likely to be enrolled. The latest example of this “welcome mat” effect came in Virginia, where, since the state began Medicaid expansion enrollment for adults in January 2019, more than 25,000 children gained coverage in Medicaid and CHIP.

The importance of providing health care during the earliest years of life cannot be overstated. Over 80% of all brain development happens before a child’s sixth birthday, and early experiences have long-term consequences on their future health and well-being. That’s why Oregon recently passed a law allowing children up to age six to remain continuously eligible for Medicaid. 

According to U.S. Department of Health and Human Services, babies should have six “well-baby” visits before their first birthday, and an additional seven well-child visits before they turn four years old to ensure they are healthy and meeting the early developmental milestones needed to have a strong start in life. Public investment in continuous Medicaid eligibility for children up to age six is proven to increase health outcomes during the earliest years of a child’s life by ensuring babies and young children are covered by health insurance to attend these well-baby and child doctor visits.

Minnesota’s future prosperity depends on the well-being of every adult, every infant, and every young child. The Legislature can strengthen Minnesota’s care and support for our neighbors and families by ensuring continuous Medicaid eligibility for adults and kids. Families would no longer face the threat of losing coverage due to small fluctuations in income or issues with periodic data matching, and all children could receive critical well-child preventative care throughout the crucial developmental years, with the benefits compounding well into adulthood.