Revenue Cycle

Gaps in Medicaid coverage may cause increased hospitalizations

Patient Financial Services Weekly Advisor, January 2, 2009

A five-year retrospective study published recently in the Annals of Internal Medicine proposes that requiring patients to re-qualify for Medicaid every few months may save money in the short run, but is more expensive to the healthcare system overall, the New York Times reports. 

The Medicaid program requires participants to continually prove their eligibility for the program. Participants are cut off from the program if documentation proving eligibility is not submitted correctly and completely. This process is meant to keep ineligible participants from staying in the program, but causes some participants to lose the benefits that allow them to keep themselves healthy.

These participants cannot afford their medications, or access to a primary care physician, and sometimes end up seeking expensive care in a hospital. Once in the hospital, most were able to regain Medicaid coverage, according to the study.

The study took place in California and showed that 62% of Medicaid participants experienced gaps in coverage within the five years. The participants who experienced these gaps were 3.6 times more likely to be hospitalized than those participants who maintained continual coverage.

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