Xu Ji, doctoral candidate at Emory's Rollins School of Public Health, is lead author on a paper published in Medical Care, that demonstrates the negative impact breaks in Medicaid coverage can have on populations suffering from severe depression. 

The study examined records from 139,164 adults with major depression from 2003-2004 and found that of those, the patients with disruptions to Medicaid coverage visited the emergency room with greater frequency and had longer hospital stays when they were able to return to their plans than those with continuous coverage.

"These vulnerable populations are being hit hard by the loss of Medicaid coverage when they need help," says Ji.

The study also found that interruptions in coverage were related to state policies regarding Medicaid re-enrollment. The disruption rate was significantly lower among beneficiaries living in states with more streamlined re-enrollment policies (i.e., re-enrollment occurs annually) than among those living in states that required more frequent re-enrollment (i.e., every six months or more frequently).

Prior to the Affordable Care Act (ACA), individual states were not limited to the frequency a beneficiary needed to re-enroll each year in order to maintain Medicaid coverage. When the ACA passed, it included a provision to simplify re-enrollment procedures for Medicaid beneficiaries (eligible based on income) by requiring states to recertify eligibility no more frequently than once a year.

The proposals currently under review include massive cuts to Medicaid and the option of reinstating more frequent recertification for eligibility. The study suggests that the proposed policies could exacerbate disruptions in Medicaid coverage for those with severe depression. 

According to Ji, "Without a constant source of coverage patients could end up missing visits with their doctors until their depression worsens to the degree that emergency visits and hospitalizations are required."