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Study finds Virginia Medicaid expansion increased financial security

Person signs paper with several people behind them
Then-Gov. Ralph Northam signs Virginia's 2018 budget, which expanded Medicaid eligibilty in the state. A recent study found that those who received Medicaid following the expansion experienced less financial stress. (File photo: Craig Carper/VPM News)

Virginia Medicaid recipients reported the program has helped them achieve more financial security — and not just in medical costs, but in other areas such as food and housing, according to a study published this month in the journal Health Affairs.

The research focused on people who were able to enter the program after state lawmakers expanded Medicaid in 2019. Nearly 675,000 Virginians, including about 175,000 in the central region of the commonwealth, enrolled in Medicaid after the General Assembly expanded who was eligible to include single people, as well as those making up to 138% of the poverty line, double the previous baseline.

Hannah Shadowen, a medical student at Virginia Commonwealth University who is also pursuing a Ph.D. in health care policy, led a survey of post-expansion Medicaid recipients alongside state officials at the Virginia Department of Medical Assistance Services.

An initial survey in 2019 asked people to respond with their level of financial worries in the year before they enrolled; a follow-up in 2020-21 asked the same question a year later. The paper includes adjusted statistics to account for slightly different pools of respondents in each survey to account for differences like sex, marital status and education level

The likelihood of respondents being worried about medical costs dipped by one-third in the adjusted totals. But respondents also reported a 5% decrease in concern over housing and nearly an 8% dip in worry over food.

“We saw that it was a tool not only to pay for their medical bills, which is really kind of what we traditionally think of [as] health care, but it also really decreased the worry about paying for all the other things in life,” Shadowen said.

Rural recipients reported an especially large decrease in worry surrounding paying medical bills, with results showing a drop of 55% compared to 41% for nonrural residents. Black recipients of Medicaid showed a large decrease in concern over housing and medical costs, compared to non-Hispanic white recipients.

Debbie Oswalt, executive director of the Virginia Health Care Foundation, said the results drove home how Medicaid expansion enabled medical care that previously might have been delayed. Another study published in May found a 7 to 8% increase in Virginia’s insured rate among enrollees living below the federal poverty line.

“I’m so happy and glad that we expanded Medicaid before the pandemic came, because look at how many more people needed that kind of coverage because they lost their jobs during the pandemic,” Oswalt said.

The second half of the survey coincided with several pandemic aid measures, ranging from Virginia’s rent relief program to federal stimulus checks. While those initiatives might have factored into the findings, Shadowen said the consistency in responses from earlier months of the pandemic to later periods suggested the other programs didn’t substantially alter the findings.

Virginia has temporarily suspended its annual eligibility reviews of people on Medicaid during the pandemic. State officials expect up to 400,000 people to lose coverage once the reviews resume, although they said some of those people have likely found health insurance elsewhere. The change would be sparked by the expiration of the federal pandemic health emergency, but it’s unclear when that will happen.