Study Links Hospitalizations to Lapses in Medi-Cal Coverage

Medi-Cal beneficiaries who faced gaps in coverage were more than three times as likely as those with continuous coverage to be hospitalized for chronic illnesses, according to a five-year retrospective study published in the Annals of Internal Medicine, the New York Times reports.

Medi-Cal is California's Medicaid program (Rabin, New York Times, 12/17).

Background

For the study, funded by the Commonwealth Fund, researchers examined use of health services by Medi-Cal beneficiaries from 1998 to 2002.

During that period, beneficiaries were required to verify their eligibility every three months. The policy was changed in 2001, and the state now requires proof every six months (Wallbank, CQ HealthBeat, 12/16).

Findings

The study found that about 62% of Medi-Cal beneficiaries had a gap in coverage during the study period, and those beneficiaries were 3.6 times more likely to be hospitalized for chronic conditions such as diabetes, asthma and high blood pressure.

According to the Times, heart failure, diabetes and chronic obstructive pulmonary disease were the leading causes of hospitalizations among the beneficiaries.

The study found that most beneficiaries were admitted to the hospital within three months of losing coverage and that most qualified again for Medi-Cal once they were in the hospital.

Implications

According to the Times, the study "calls into question the practice" of having Medi-Cal beneficiaries frequently verify their eligibility and suggests that gaps in coverage can cost states more in the long run.

Andrew Bindman, lead author of the study and professor of medicine at UCSF, said that Medi-Cal requires eligibility checks to prevent waste and fraud in the program, but the study "brings home the fact that in many ways Medi-Cal ends up paying for these patients in the long run, and doing it in a more expensive setting than would have been the case if they had maintained the coverage."

CMS spokesperson Mary Kahn said recertification requirements are set by states and the federal government requires recertification once per year.

She said, "It certainly does not come as a surprise that people who routinely lose access to medical care would suffer health consequences," adding, "This is not strictly a situation with Medicaid -- people who lose private health insurance when they lose a job or age out of coverage often don't seek care until their illness is critical" (New York Times, 12/17).

New Verification Rules

The study comes as California prepares to require children enrolled in Medi-Cal to prove eligibility every six months, rather than annually as is currently the case.

Tony Cava -- a spokesperson for the state Department of Healthcare Services, which administers Medi-Cal -- said the decision is based on budget shortfalls.