Cost Sharing Studies and the Impact on Medicaid Beneficiaries
Cost-sharing has been one of the most studied aspects of the Medicaid program and data overwhelming supports that copayments make it harder for beneficiaries to afford medical services, while premiums make it harder for eligible beneficiaries to enroll and maintain coverage. The adverse consequences of cost sharing include poorer health and increased use of high-cost services like emergency rooms.
When 100,000 people lost Medicaid coverage in Missouri because of higher cost-sharing, the number of uninsured individuals increased, hospitals became burdened with more uncompensated care, and revenue short falls forced community health centers to charge patients more and obtain larger state grants.
Cost sharing in Medicaid forces families to choose between financial hardship and reducing their children?s enrollment and usage of medical services.
Cost sharing increases in Oregon?s Medicaid Program led to a dramatic reduction in enrollment. Those who left the program because of cost-sharing increases had inferior access to needed care, were significantly less likely to visit a primary care physician, and used the emergency room more often than those leaving for other reasons.
The Oregon Medicaid program applying copayments to beneficiaries did not provide the expected cost savings because individuals refrained from preventative care in favor of more costly hospital emergency care.
Neal T. Wallace et al., How Effective Are Copayments in Reducing Expenditures for Low-Income Adult Medicaid Beneficiaries? Experience from the Oregon Health Plan
, 43 HEALTH SERV. RES. 515 (2008), available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2442363/
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