Impact of loss of Medicaid coverage on access to health care: The TennCare experience

TennCare, Tennessee's Medicaid managed care program, disenrolled 170,000 of its 1.3 million beneficiaries beginning in mid-2005. This study was undertaken to determine the impact of this disenrollment on subsequent health insurance coverage and access to health care.

Telephone interviews were conducted approximately 8 months after disenrollment began on a statewide, randomized sample of TennCare recipients who were 19 years old or older and who had been on TennCare for a minimum of 24 months. This included 244 TennCare recipients who were not disenrolled (Group I) and 513 prior beneficiaries who had been disenrolled (Group II).

Of the 513 disenrollees, 147 (27.1%) retained or acquired other health insurance (Group IIA) and 366 (71.3%) were uninsured (Group IIB). Differences among the three groups were compared using chi-square methods.

The percentage of respondents without a designated primary care provider was 9.8% for those not disenrolled (Group I), 15.6% for insured disenrollees (Group IIA) (p>.05 vs. Group I) and 37.6% for the uninsured disenrollees (Group IIB, p<.01 vs. Group I and IIA). The percentage of respondents in Group I (nondisenrolled) who did not receive needed medical care was 2.5%; the percentage was 18.2% in Group IIA (insured disenrollees) (p<01 vs Group II) and was 55.5% in Group IIB (uninsured disenrollees) (p<.01 vs Group I and vs Group IIA). The percentages of those who did not fill a needed medication prescription was 22.1% for Group I, 28.0% for Group IIA (p>.05 vs. Group I) and 46.7% for Group IIB (p<.01 vs Group I and Group IIA). Of Group IIB (uninsured disenrollees), 70.6% reported being “somewhat dissatisfied” or “very dissatisfied” with their health care. This was significantly higher than for either Group IIA (insured disenrollees) (45.4%, p<.01 vs Group IA) and Group I (not disenrolled) (40.6%, p>.05 vs Group IIA, p<.01 vs Group IIB).

These findings demonstrate that, approximately 8 months after loosing TennCare coverage, most disenrollees remained uninsured. Those who became uninsured reported less access to and satisfaction with care than did those remaining on TennCare or with other insurance coverage. Disenrollees with other insurance coverage (Group IIA) had measures of access intermediate between those continuously enrolled (Group I) and those who were uninsured (Group IIB), suggesting that the alternative coverage was less effective than was TennCare. Results of subsequent surveys, approximately 14 and 20 months after disenrollment, will assess the time trends in these factors.