A significant challenge in the United States healthcare system is ensuring coverage for the millions of uninsured individuals, a substantial portion of whom are actually eligible for Medicaid. Hospital-based insurance linkage programs have emerged as a vital strategy to address this gap, assisting eligible patients with Medicaid enrollment during hospital encounters. However, a crucial question arises regarding the retroactive nature of these care programs: Does the ability to obtain Medicaid coverage retroactively through these programs truly translate to improved healthcare utilization and health outcomes? This research delves into this question by evaluating the impact of hospital-based insurance linkage programs, specifically focusing on patients who gain retroactive Medicaid coverage.
This retrospective cohort study analyzed data from adult patients aged 18-64 who were hospitalized between 2016 and 2021. The study compared three distinct groups: patients who obtained insurance retroactively via insurance linkage (RI), patients who already had Medicaid upon admission (MI), and patients who remained uninsured (UI). The primary focus was to determine if patients had at least one visit with a primary care provider (PCP) within 12 months following their hospital admission. Secondary outcomes assessed included whether patients had an assigned PCP, the frequency of emergency department (ED) revisits, and hospital readmission rates. Furthermore, for patients diagnosed with diabetes and hypertension, the study tracked key health indicators – hemoglobin A1c (HbA1c) and blood pressure (BP) readings – over a 12-month period.
The findings revealed that hospital-based insurance linkage programs successfully enrolled a significant majority (74.8%) of previously uninsured patients (2905 out of 3882) into insurance with retroactive effect. Multivariable analysis demonstrated that patients with retroactive insurance (RI) were significantly more likely – 14% more likely (OR 1.14, p = 0.020) – to have completed at least one PCP visit within 12 months compared to patients who had pre-existing Medicaid (MI). In stark contrast, uninsured patients (UI) were 29% less likely (OR 0.71, p = 0.003) to have a PCP visit. Interestingly, both Medicaid groups, including those with retroactive enrollment (RI) and pre-existing coverage (MI), experienced a higher number of ED revisits compared to the uninsured group (p<0.001).
In conclusion, this research underscores the significant reach and impact of hospital-based insurance linkage programs in connecting uninsured patients to crucial healthcare coverage. The fact that these programs often facilitate retroactive Medicaid coverage is a key factor in their success. The study demonstrates a clear association between retroactive insurance gained through these programs and increased utilization of both acute and outpatient healthcare services, as evidenced by higher rates of PCP visits and ED revisits among the retroactively insured. These findings highlight the critical role of acute care encounters as opportune moments to link patients with insurance. By effectively leveraging these touchpoints, healthcare systems can take a substantial step towards improving health outcomes for vulnerable populations through programs that facilitate retroactive care program enrollment and bridge the insurance gap.
