Research Shows Implications for Cuts to Medicaid and Eligible Services as Pandemic Protections End
Black and Hispanic seniors whose annual income is slightly above the federal poverty level are more likely than white seniors to face cost-related barriers to accessing health care and purchasing medications for chronic conditions , according to new research.
The analysis, published in the journal JAMA Internal Medicine by a team from the University of Pittsburgh School of Public Health and the University of Michigan, links these disparities to Medicaid “cliff”that is, the abrupt end of Medicaid supplemental insurance if a person’s income exceeds the federal poverty level.
For low-income seniors, Medicaid helps reduce medical costs by covering most copays. However, if an older adult’s income exceeds the Medicaid eligibility level, which can lead to a sudden increase in copays, the study suggests that this makes it more difficult for black and Hispanic older adults with modest incomes to pay for health care, compared with whites and similar incomes.
“Chronic disease risks among older adults of color often go unaddressed due to barriers related to cost of care, and our research shows that this Medicaid cliffhanger contributes to these barriers,” said Eric T. Roberts, assistant professor of health policy and management at Pitt Public Health. Fixing it so that Medicare beneficiaries don’t have to face substantially higher copays above the poverty level could reduce health care disparities among our nation’s seniors.”
One option is to convert the “cliff” to a “slight hill,” reducing Medicaid assistance to seniors with incomes just above the federal poverty level,” Roberts added.
Renuka Tipirneni, M.D., lead author of the study and an assistant professor of internal medicine at the UM School of Medicine, notes that the results also have implications for a phenomenon happening right now: the “rollback” of automatic eligibility for Medicaid for people who enrolled during the pandemic who have not had to provide income information to show continued eligibility.
“We found that older adults who lose Medicaid coverage are less likely to see a doctor and be able to fill prescription drugs, and this was worse among black and Hispanic older adults,” he said. “So I’m not only concerned about older adults in general with the rollback of Medicaid, but I’m concerned about racial and ethnic disparities in care that could worsen as older adults lose Medicaid coverage.”
Medicare, the federal social insurance for medical assistance for people over 65 and disabled, may suffer an increase in expenses, including deductibles and copayments. Medicare beneficiaries with incomes below 100% of the federal poverty level, about $14,600 per year, can receive Medicaid supplemental insurance to offset these costs and automatically receive help to reduce medical expenses.
However, unlike other federal programs that reduce aid on a sliding scale, such as the Supplemental Nutrition Assistance Program that helps people buy food, those with incomes just above the poverty level are excluded from Medicaid.
Roberts, Tipirneni, and their colleagues obtained data on 8,144 Medicare beneficiaries with incomes below 200% of the federal poverty level. They examined health care use by recipients on both sides through Medicaid eligibility, comparing results between black and Hispanic recipients and white recipients.
Being just above the federal poverty level, and therefore not eligible for Medicaid, was associated with a 21% drop in annual outpatient visits and a 15% drop in prescriptions dispensed for black and Hispanic Medicare beneficiaries, but there were hardly any changes in the case of the whites.
“We have found, and other studies support this, that white beneficiaries are more likely to have savings to cover their medical expenses,” says Roberts. “The income that the federal government takes into account to determine Medicaid eligibility may make it appear that black and Hispanic recipients have the same ability as whites to pay for care. But the reality is that they don’t have the same reservations, and we’re seeing the impact of that in their foregoing doctor visits and necessary medications.”
Black and Hispanic Medicare recipients are more likely than whites to suffer from chronic diseases that can be treated with medicines, such as diabetes and heart disease.
“The Medicaid ‘cliff’ is doubly concerning because it causes black and Hispanic adults to fill fewer medications and makes it harder for them to keep regular doctor’s appointments, which makes it harder to get prescriptions in the first place,” Roberts said.
The findings support expanding Medicaid eligibility for older adults and reducing Medicaid assistance above the poverty level. These changes could complement the measures of the Law of Reduction of inflation aimed at making drug costs more affordable for older people, the researchers noted.
Other authors of this study are Youngmin Kwon and Alexandra Hames, both from Pitt; J. Michael McWilliams of Harvard University and Brigham and Women’s Hospital; and John Ayanian of the University of Michigan. Ayanian directs and Tipirneni is a fellow at the UM Institute for Health Policy and Innovation. Both are general internal medicine providers at Michigan Medicine, UM’s academic medical center.
Adapted from a University of Pittsburgh statement by Allison Hydzik and adapted to Spanish by Juan Ochoa, Michigan News.