How Should Children's Medicaid Eligibility Be Monitored?

Medicaid provides health insurance for nearly 4 in 10 children in the United States, but this coverage can be unstable as a result of annual eligibility redetermination requirements. After the continuous Medicaid coverage mandate during the COVID-19 pandemic ended in March 2023, states were required for the first time to publicly report standardized metrics on terminations and renewals resulting from eligibility redeterminations. Our understanding of redeterminations and their contribution to coverage gaps had been constrained by data limitations, but states' reporting practices offered researchers and policymakers key insights into these processes and associated coverage outcomes.

Experiences with Medicaid unwinding among low-income adults in 4 southern states.

After states initiated Medicaid redeterminations following the end of the Medicaid continuous coverage provision, millions of people lost Medicaid coverage. To date, there is limited evidence evaluating how people experienced this "unwinding" process. Using a survey of low-income adults in 4 southern states, we assessed awareness of unwinding, experience with state-based outreach, and understanding of coverage changes.

Coverage and Access Changes During Medicaid Unwinding.

Importance: States resumed Medicaid eligibility redeterminations, which had been paused during the COVID-19 public health emergency, in 2023. This unwinding of the pandemic continuous coverage provision raised concerns about the extent to which beneficiaries would lose Medicaid coverage and how that would affect access to care.

Objective: To assess early changes in insurance and access to care during Medicaid unwinding among individuals with low incomes in 4 Southern states.

Survey-Reported Coverage in 2019-2022 and Implications for Unwinding Medicaid Continuous Eligibility.

Importance: Policy changes and the COVID-19 pandemic affected health coverage rates, and the "unwinding" of Medicaid's continuous coverage provision in 2023 and 2024 may cause widespread coverage loss. Recent coverage patterns in national survey and administrative data can inform these issues.

Objective: To assess national and state changes in survey-based Medicaid, private insurance, and uninsured rates between 2019 and 2022, as well as how these changes compare with administrative Medicaid enrollment totals.

Small Marketplace Premiums Pose Financial And Administrative Burdens: Evidence From Massachusetts, 2016-17.

Health insurance premiums are primarily understood to pose financial barriers to coverage. However, the need to remit monthly premium payments may also create administrative burdens that negatively affect coverage, even in cases where affordability is a negligible concern. Using 2016-17 data from the Massachusetts health insurance Marketplace and a natural experiment, we evaluated how coverage retention was affected by the introduction of nominal (less than $10 for most enrollees) monthly premiums for plans that previously had $0 premiums.

Medicaid by Any Other Name? Investigating Malleability of Partisan Attitudes toward the Public Program.

Context: Medicaid is the largest health insurance program by enrollment in the United States. The program varies across states and across a variety of dimensions, including what it is called; some states use state-specific naming conventions, for example, MassHealth in Massachusetts.

Methods: In a preregistered online survey experiment (N = 5,807), the authors tested whether public opinion shifted in response to the use of state-specific Medicaid program names for the provision of information about program enrollment.

Popular… to a Point: The Enduring Political Challenges of the Public Option.

Policy Points A decade after failing to make it into the Affordable Care Act, the public option reemerged as a health reform goal at both the national and state levels, with polls reporting strong, bipartisan support. A 2020 poll that probed both support for one public option approach (Medicare "buy-in") and attitudes toward government suggests that differences in these attitudes could plague reform advocates' efforts. Although the COVID-19 pandemic viscerally highlighted the need for a more coherent health care system-including universal coverage-other recent evolutions in the broader US political context could undermine reform.

Turnover in Zero-Premium Status Among Health Insurance Marketplace Plans Available to Low-Income Enrollees.

Importance: Recent subsidy enhancements in Affordable Care Act (ACA) Marketplaces made many low-income enrolles (below 150% of the federal poverty level [FPL]) eligible for 2 free silver-tier plans. eligible for 2 free silver-tier plans. However, an unintended consequence of this structure is that the identity of which silver plans are free will often "turn over" between years, requiring that enrollees actively initiate premium payment (or lose coverage).

The Affordable Care Act's Missing Consensus: Values, Attitudes, and Experiences Associated with Competing Health Reform Preferences.

Ten years after its enactment, public support for the Affordable Care Act (ACA) still only reaches a scant majority. Candidates for the presidency-and the sitting president-have endorsed health reforms that would radically transition US health care away from the current system upon which the ACA was built. Few opinion surveys to date have captured dominant preferences among alternative health reform policies or characterized attitudes and experiences that might be associated with policy preferences.

The US Affordable Care Act: Reflections and directions at the close of a decade.

In this month's Editorial, PLOS Medicine Academic Editor Zirui Song and his colleague Adrianna McIntyre discuss outcomes and possible futures for the United States Affordable Care Act as it nears the ten year mark.