SDoH and COVID-19: Medicaid Expansion

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Original story posted on: August 12, 2020

And then there were 12: Medicaid expansion, COVID-19, and the SDoH

Elections in Missouri last week moved that state into the expansion fold. Voters approved creating a state constitutional amendment opening Medicaid eligibility to healthy adults, as of July 2021.

This win was a big one, given strong opposition from conservative and rural voters in the state. However, 1.2 million voters, 53 percent, said yes, which was enough. Why is this such a big issue?

Here’s Medicaid expansion 101:

  • The program opens Medicaid eligibility to individuals and families with incomes up to 138 percent of the federal poverty level. The federal government covers 90 percent of expansion costs, a much higher matching share than for low-income, disabled, and elderly people traditionally covered by Medicaid.
  • The poverty level for 2020 allows for $12,700 for a family of one person, with $4,430 added per person, up to eight people, so, $26,200 for a family of four.
  • As of today, 37 states, plus the District of Columbia, already have or will soon expand Medicaid.
  • Studies show big savings from Medicaid expansion, as high as $39 million a year in Missouri, primarily from eliminating other healthcare spending.
  • In states that expanded Medicaid, the program covered 35.8 percent of all unemployed adults ages 19-64;
    • In non-expansion states, Medicaid reached only 4 percent of unemployed adults. The result? The uninsured rate among the unemployed in non-expansion states was nearly double the rate of expansion states: 42.5 percent versus 22.6 percent.

The 12 states at issue know who they are, but for your information, they’re Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming. Ironically, seven of these states have the highest numbers of COVID-19 patients in the U.S.

The number of people covered by Medicaid was down nationally, pre-pandemic, but has risen sharply since. There were 72.3 million Medicaid recipients in April, with states rising by 10 percent on average. Some states have seen enrollment rise by as many as 1.7 million people. Nationally, we’re looking at an increase of 17-20 million people; that’s how many are unemployed and eligible for Medicaid. Are we having fun yet? But wait, there’s more. Unless unemployment is extended, it will be a tougher challenge for the population, hospitals, healthcare systems, and providers who care for these people.

COVID-19 is a public health crisis. Everyone is at risk, with profound strain on our healthcare system, and especially for those dealing with the social determinants of health (SDoH).

States are stepping up with their own resources, with the federal government having provided stimulus funds. Yet will those funds be enough?

Our readers had thoughts about that question, with the results viewable here.

Programming Note: Ellen Fink-Samnick is a permanent panelist on Monitor Mondays. Listen to her live reporting every Monday at 10 a.m. EST.

Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP

Ellen Fink-Samnick is an award-winning healthcare industry expert. She is the esteemed author of books, articles, white papers, and knowledge products. A subject matter expert on the Social Determinants of Health, her latest books, The Essential Guide to Interprofessional Ethics for Healthcare Case Management,  Social Determinants of Health: Case Management’s Next Frontier (with Foreword by Dr. Ronald Hirsch), and End of Life Care for Case Management are published through HCPro. She is a panelist on Monitor Mondays, frequent contributor to Talk-Ten-Tuesdays, and member of the Editorial Advisory Boards of Professional Case Management, Case Management Monthly, and RAC Monitor. Ellen also serves as the Lead for Rise Association’s Social Determinants of Health Community.

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