New Developments at DHHS
First Look: MaineCare Expansion Enrollees' Health and Use of Services
August 16, 2019
Since Governor Mills signed her executive order on January 3 to expand Medicaid (MaineCare), more than 34,000 people have been enrolled. Early information about MaineCare expansion members is beginning to come in, and the Department has started to take a closer look at the health profile of this newly covered group.
Regularly Reported Information
We've previously shared some demographic information about expansion enrollees, including:
- Among adults without children, 47 percent are female. Among parents and caretaker relatives, 62 percent are female.
- Among adults without children, those aged 19-29 and 50-59 represent the largest age groups. Among parents and caretaker relatives, the largest age groups are those aged 30-39 and 40-49.
We looked at data from MaineCare claims, or bills submitted to MaineCare by health providers who are caring for MaineCare members. These claims are for services to about 20,000 people enrolled through the expansion from July 31, 2018 to May 31, 2019. While the implementation of expansion officially began on January 3, 2019 with Governor Janet Mills' executive order, the federal government approved under the expansion with an effective date of July 2, 2018.
This claims information is preliminary and does not necessarily represent what the experience for expansion enrollees will be when the expansion is fully implemented. For example, there is usually a time lag between when a member receives health care and when their provider submits the bill to MaineCare. Pent-up demand (described below) may also play a role. We may not have a full picture of the health profile of the expansion population for a number of months.
We compared this preliminary information on enrollees to that of two groups: a population likely eligible for the expansion and adults who are already enrolled in MaineCare outside of expansion. The estimates of the eligible population are from an analysis of Behavioral Risk Factor Surveillance System (BRFSS) data by the Muskie School of Public Service at the University of Southern Maine. The researchers created a detailed profile of adults without children who they estimate are eligible for the expansion based on income data. This allows us to compare trends among those who are actually enrolled under expansion to those who could potentially enroll, and to a roughly similar group of non-expansion MaineCare members.
Non-expansion enrollees in this analysis include parents and people ages 19 and 20 years old enrolled in MaineCare during the same period as the expansion group (July 31, 2018 to May 31 ,2019). This group excludes enrollees with disabilities, those who are pregnant, or those older than age 64, as these groups are covered under different provisions. This allows us to better compare trends among those who are newly enrolled in MaineCare to those enrolled under eligibility rules that pre-date the expansion.
More Young People Than Expected
While the expectation may be that older people would sign up first, since they are more likely to need health care, in reality, 51% of expansion enrollees are younger than age 40. In comparison, 28% of those potentially eligible are ages 18 to 44, indicating that we may see older people enroll later in the expansion, among other possibilities.
Slightly Likelier than Current MaineCare Enrollees to have Chronic Conditions
The most common chronic conditions found among the broader population of Maine also appear among expansion enrollees. In initial data, 61% of expansion enrollees reported one or more chronic conditions, including: overall substance/opioid use disorders, mental health conditions, diabetes, heart disease, chronic obstructive pulmonary disease, and hypertension. These conditions are also common among non-expansion adult enrollees.
A snapshot of prescription drug claims shows similarity between expansion and non-expansion enrollees. Treatments for opioid use disorder and diabetes are common among both groups. Additional similarities emerge in the volume of prescriptions for conditions such as asthma, chronic pain/opioids, and depression. When examining prescriptions by cost, MaineCare spends more on expansion versus non-expansion enrollees for conditions such as Hepatitis C, HIV, cancer, and inflammatory conditions that require biologic drugs.
Greater Use of Services than Current MaineCare Enrollees
The MaineCare expansion enrollees were more likely to have an inpatient admission than adults otherwise enrolled in MaineCare. They also were substantially more likely to use an emergency room. This is not surprising given their somewhat more chronic health profile and the fact that emergency rooms are often the regular source of care for people who are uninsured.
Higher health care use among the newly eligible expansion enrollees may also reflect pent-up demand. People who are uninsured often skip necessary care, which may worsen their health problems. As such, when they gain coverage, they often immediately use more and potentially more intense care than others. Studies on the Medicaid expansion in other states have documented this effect – along with a subsequent decline in utilization, including use of emergency departments, over time.
We will report related cost data when we have enough information to assess trends. But so far, spending for opioid use disorder treatment for all MaineCare members, including expansion enrollees, totaled $28.1 million from January 2019 to June 2019. Federal funding covered $19.6 million of that total. The time lag applies to these figures, which represent claims paid over those six months, not necessarily treatment provided during that time.
Research shows that overall, Medicaid expansion is associated with better access to health care, more affordable coverage, and improved health outcomes – without a significant, consistent increase in state spending.