COVID-19: State Medicaid Enrollment Rising; Similar National Trend

WHA’s Borgerding addresses payer mix challenges on WisBusiness podcast

June 25, 2020

The COVID-19 pandemic and the economic toll it has taken on the nation’s and state’s economy is likely an important factor behind a recent increase in the number of citizens enrolled in the state’s Medicaid programs. Wisconsin Medicaid enrollment numbers have grown since the pandemic first took major effect in March 2020, with overall enrollment increasing by nearly 72,000 people from March to May. The largest increase was in the BadgerCare Plus program, with about 65,000 added to the rolls. This program includes children, pregnant women, parents/caretakers and childless adults. 
WHA President and CEO Eric Borgerding discussed the challenges hospitals and health systems face under these “payer-mix” changes in this WisBusiness: The Podcast episode, first aired on June 19. Borgerding calls the COVID-19 pandemic “a one-two punch on health care right now,” with hospitals first suffering significant revenue difficulties due to following federal directives to eliminate all non-emergency services and procedures in preparation for a possible COVID-19 case surge, and now facing further challenges as patients may move from employer-sponsored insurance to Medicaid or be uninsured altogether.  
“As the general economy suffers and people lose their jobs and maybe lose their health insurance, or they transition onto a state government health care program like Medicaid where reimbursement for health care is far below the actual cost to provide health care – that creates another financial pressure,” Borgerding says on the podcast. “Payer mix is changing – it’s shifting from commercial health insurance to either no insurance or government programs like Medicaid. Just at a time when health care is still reeling from the financial impacts of shutting down services during COVID, there’s going to be this trailing financial impact.”
As this story from the Pew Charitable Trusts points out, similar increases are occurring in Medicaid programs across the country. While Wisconsin’s uninsured rate has historically been low – dropping from 11.3% in 2013 to 5.5% in 2018, which is the latest official data available – numerous studies examining the pandemic’s potential effect on health insurance coverage consistently indicate that higher unemployment rates likely lead to increases in both Medicaid enrollments and in the number of uninsured. Various studies include research from the Advisory Board, a health policy brief from the Robert Wood Johnson Foundation and the Urban Institute, and an early April 2020 report from Health Management Associates.

This story originally appeared in the June 25, 2020 edition of WHA Newsletter