Utah’s Medicaid Expansion and the COVID-19 Pandemic

During the 2018 midterm elections, Utah voters approved full Medicaid expansion under the Affordable Care Act for individuals with incomes up to 138% of the federal poverty level (FPL). Utah legislators then applied to the federal Centers for Medicare and Medicaid Services (CMS) for a partial expansion for individuals with incomes up to 100% of the FPL. In December 2019, CMS approved an expansion up to 138% of the FPL in Utah, starting on January 1, 2020. The Medicaid expansion coincided with the COVID-19 pandemic, which also impacted Medicaid enrollment and retention.

The overarching goals of this analysis are to generate evidence for Utah legislators and healthcare officials regarding health insurance enrollment and characteristics of Medicaid and non-Medicaid insured persons, and to assess clinical quality and receipt of high-value care for these populations.

To achieve these goals, we will use two time periods: 1) pre-Medicaid expansion/pre-COVID (January 1, 2019-December 31, 2019) and 2) post-Medicaid expansion/during-COVID (January 1, 2020-June 31, 2021).

Our research objectives are three-fold:

(1) Using the Utah all payer claims database and Utah Population Database, assess the increase in Medicaid enrollment during the COVID-19 pandemic, the type of coverage individuals had prior to enrolling in Medicaid, and whether the increase in enrollment during the pandemic was driven by new enrollment versus retaining existing enrollees due to the Maintenance of Effort provision in place during the Public Health Emergency.

(2) Compare the demographic and clinical characteristics of the newly enrolled adult Medicaid population to the adult population previously enrolled in Medicaid.

(3) Assess the clinical quality of the care received by the newly enrolled adult Medicaid population and determine whether it is high-value.

Current Status

2024-02-13
Introduction:
During the 2018 midterm elections, Utah voters approved full Medicaid expansion under the Affordable Care Act for individuals with incomes up to 138% of the federal poverty level (FPL). Utah legislators then applied to the federal Centers for Medicare and Medicaid Services (CMS) for a partial expansion for individuals with incomes up to 100% of the FPL. In December 2019, CMS approved an expansion up to 138% of the FPL in Utah, starting on January 1, 2020. The Medicaid expansion coincided with the COVID-19 pandemic, which also impacted Medicaid enrollment and retention.
The overarching goals of this analysis are to generate evidence for Utah legislators and healthcare officials regarding health insurance enrollment and characteristics of Medicaid insured persons and to assess clinical quality and receipt of high-value care for this population.
To achieve these goals, we use two time periods: 1) pre-Medicaid expansion/pre-COVID (January 1, 2019-December 31, 2019) and 2) post-Medicaid expansion/during-COVID (January 1, 2020-December 31, 2021). Our research objectives are three-fold:
(1) Using the Utah All-Payer Claims Database, assess the increase in Medicaid enrollment during the COVID-19 pandemic, the type of coverage individuals had prior to enrolling in Medicaid, and whether the increase in enrollment during the pandemic was driven by new enrollment versus retaining existing enrollees due to the Maintenance of Effort provision in place during the Public Health Emergency.
(2) Compare the demographic and clinical characteristics of the newly enrolled adult Medicaid population to the adult population previously enrolled in Medicaid.
(3) Assess the clinical quality of the care received by the newly enrolled adult Medicaid population and determine whether it is high value.

Current Status:
The Utah All-Payer Claims Database (APCD) contains information on insurance claims – both public and private – incurred in Utah. Our focus was on Medicaid enrollees and privately insured adults between the ages of 19-64, all with medical coverage rather than just dental or pharmacy coverage. We combined member-level variables with member-month variables to determine the total number of Medicaid enrollees per month between January 2019 through December 2021. Our dataset contained a cohort of 1,537,994 individuals aged 19-64. Among this 19-64 year-old population, 285,031 were ever enrolled in Medicaid medical coverage at some point in 2019-2021.
121,868 individuals newly enrolled in Medicaid (68,546 in 2020 and 53,322 in 2021). Of these, 32,722 (26.85%) transitioned from private insurance, while 89,146 (73.15%) were likely uninsured (i.e., lacked documented insurance in the Utah APCD).
We also analyzed demographic information (age and gender) and health risk using the Gagne comorbidity index. The results supported our hypotheses, indicating that newly enrolled Medicaid individuals during the pandemic were more likely to be male, younger, and healthier than previously enrolled Medicaid enrollees.
In the next steps, we will determine the clinical quality of care received by the newly enrolled Medicaid population.