Abstracts

Rationale: About 21% of adult Medicaid participants exit the program within 12 months. 17% of those who lose their Medicaid coverage regain it, 34% acquire private insurance, and 49% remain uninsured six months later. This churning or temporary loss of Medicaid coverage is a potential threat to access to quality epilepsy care and may contribute to care fragmentation, increased use of emergency department services, higher health care costs, and unfavorable outcomes. This study was designed to assess the patterns and predictors of Medicaid coverage gaps among persons with epilepsy. Methods: We conducted a retrospective cohort study using the Ohio Medicaid enrollment and claims data from 1995 to 2005. A Medicaid coverage gap was defined as a lapse in Medicaid enrollment of one or more months preceded and followed by an enrollment or re-enrollment of at least one day. We used descriptive statistical tools, Cox Proportional Hazards, Prentice-Williams-Peterson, and Anderson-Gill models to measure the magnitude and risk factors for Medicaid first and recurrent insurance gaps among persons with epilepsy. Results: Nearly 28% of persons with epilepsy and 47% of persons without epilepsy had a Medicaid coverage gap during a median observation period of 84 and 62 months respectively. Persons with epilepsy had 27% reduced risk of experiencing recurrent Medicaid coverage gaps during the study period (AHR 0.73, 95% CI 0.72-0.75), controlling for epilepsy duration, demographic, and enrollment variables. Disability eligibility, dual Medicaid-Medicare eligibility, managed care plan, nursing home residence, comorbidity, physician visit, and 3 or more years of Medicaid enrollment were associated with reduced hazard of recurrent Medicaid coverage gaps among persons with and without epilepsy. Conversely, age less than 35, spend-down eligibility, and prior insurance gaps significantly increased the risk of recurrent Medicaid coverage gaps. Conclusions: About a third of persons with epilepsy, particularly those who are less than 35 and are on spend-down program have gaps in Medicaid coverage. To mitigate the consequences of Medicaid coverage gaps such as unmet health needs, unnecessary re-enrollment costs, post gap increased cost of health care, and compromised quality of care; policies and practices targeting this high risk group of persons with epilepsy should be put in place.