Andrew Barnes, Ph.D.
Andrew Barnes, Ph.D., associate professor of health behavior and policy.

Cost of care biggest barrier for previously uninsured Medicaid members, VCU study finds

Virginia is the first to conduct a survey of newly eligible members to understand their health care experiences prior to enrolling in Medicaid.

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A team of Virginia Commonwealth University researchers, led by the VCU School of Medicine’s Department of Health Behavior and Policy, conducted a baseline survey among 1,500 newly eligible Medicaid members in Virginia. Released today, it is the first study in the U.S. capturing health care experiences in the year prior to obtaining coverage among newly eligible members in states with recent Medicaid expansion.

Andrew Barnes, Ph.D., associate professor of health behavior and policy, talked to VCU News about the study, which is part of a larger Medicaid expansion evaluation VCU is conducting on behalf of the Department of Medical Assistance Services.

What is the scope of your research?

This particular project evaluates Medicaid expansion in Virginia. Our goal as an independent evaluator is to help state and federal governments understand whether changes in health care eligibility and coverage improve access to care, health outcomes and the quality of health care delivery. Now that more Virginians are eligible for Medicaid, for example, does access to primary care and specialty care improve for those who are newly enrolled under Medicaid expansion? The first assignment of this five-year research project was a survey among newly eligible Medicaid members.

How did you approach your research?

Of all the states that expanded Medicaid this year, Virginia is the first to conduct a baseline survey of newly eligible members to understand what their health care experience was like in the year prior to enrolling in Medicaid. We targeted newly eligible members shortly after enrollment who were likely uninsured previously, and we plan to do subsequent surveys to monitor their experience.

We used a mixed methods approach that included analyzing medical claims data, surveys of member experiences, and semi-structured interviews with, and surveys of, providers about capacity. Over the next few years, we will study if Medicaid expansion will address unmet needs and improve health, but also if members are better able to afford housing and food, just to give a few examples.

What experiences did newly eligible members describe from the prior year?

Two-thirds of newly eligible members who answered our survey reported having trouble paying medical bills in the year prior to enrollment. The national average is 14%. Yet, 1 in 4 reported paying more than $500 in out-of-pocket medical costs in the past year. And almost two-thirds of respondents said they needed medical care in the previous year, but did not get it because it was too expensive. We observed the same trend of forgoing care because of cost for prescription drugs, behavioral health care and substance use care. The financial barriers to accessing health care surfaced as a substantial problem for this population.

What do newly eligible members hope Medicaid will change for them in the coming year?

This was an open-response question in the survey, and the most common answer was access to primary care and preventive services. That’s a great sign, and it suggests that newly eligible members intend to use health care services the way they are intended to be most efficient, namely for preventive care and screenings. About one-third of respondents gave that answer.

Did any findings surprise you?

A few answers in our Virginia survey deviated quite substantially from national averages. Almost half the respondents (46%) reported being in fair or poor health, while the national average is 10%. And Virginia respondents were more likely than the national average to report having a health condition that prevented part- or full-time work (37% vs. 8% nationally). If access to health care services through Medicaid expansion improves members’ health outcomes, a portion of newly eligible members might be able to go back to work.

Detailed research findings were released by the office of Gov. Ralph Northam earlier today.