Medicaid loss linked to high mortality among low-income adults

PHILADELPHIA – While it may seem intuitive that people would die without life-saving medications, Penn and Harvard researchers have connected losing a federally funded prescription drug assistance program and an increase in mortality. The program, called the Medicare Part D Low-Income Subsidy (LIS), helps 14.2 million low-income Medicare beneficiaries, many of whom are older Americans, afford their medications. Nationally, 12.5 million people who are eligible for and enrolled in both Medicare and Medicaid (“dual eligibles”) automatically qualify for the LIS, which is worth about $6,200/year. 

The study, published today in New England Journal of Medicine by researchers at the University of Pennsylvania Perelman School of Medicine and Harvard T.H. Chan School of Public Health, reveals that losing Medicaid coverage—and with it, the LIS—was associated with significant increases in mortality among low-income Medicare beneficiaries.  

“When Medicare beneficiaries lose Medicaid, which happens to more than 900,000 people each year, they also risk losing the LIS and therefore, being able to afford the medicines they need,” said lead author Eric T. Roberts, PhD, associate professor of General Internal Medicine at the University of Pennsylvania Perelman School of Medicine and a Leonard Davis Institute of Health Economics Senior Fellow. 

The study included nearly 1 million low-income Medicare beneficiaries whose Medicaid coverage ended. Due to program rules, the exact month people lose Medicaid impacts when they are removed from the LIS.  

The researchers compared two groups: individuals who lost Medicaid from January to June who were removed from LIS by the following January (7–12 months later), and those who lost Medicaid from July to December lost LIS the next January (13–18 months later). This allowed the team to compare mortality rates during the period when some had lost LIS and others had not. 

Mortality was 4 percent higher among individuals who lost the LIS earlier than those who retained it for a longer period. Over the study period, more than 2,900 people died. The risks were even greater among subgroups of people who had greater clinical needs and on more expensive medications. For example, mortality was 22 percent higher among people using HIV antiretroviral therapy.   

The researchers found that over one half of individuals who lost Medicaid regained it within one year, suggesting that many were dropped from Medicaid despite remaining eligible.  

“These findings show that helping low-income Medicare beneficiaries who are eligible for Medicaid stay enrolled and retain the LIS can save lives since it preserves access to essential medications,” said senior author José F. Figueroa, MD, MPH, an associate professor of health policy and management at Harvard Chan School.  

The authors note that recent increases in Medicaid coverage losses among older adults raise concerns about potential losses of the LIS. Added Roberts, “As policymakers consider major changes to the Medicaid program, preserving Medicaid coverage for older adults is critical to ensuring that they keep the LIS.” 

Support for this work comes from the National Institute on Aging (R01AG076437; R01AG081151; RF1AG088640; T32AG000037), the Agency for Healthcare Research and Quality (R01HS029453), and Arnold Venture. 

Penn Medicine is one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, excellence in patient care, and community service. The organization consists of the University of Pennsylvania Health System (UPHS) and Penn’s Raymond and Ruth Perelman School of Medicine, founded in 1765 as the nation’s first medical school.

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