Evaluating emergency Medicaid program policy changes during the Covid-19 pandemic

ABSTRACT

Background Trauma patients are twice as likely to be uninsured as the general population, which can lead to limited access to post-injury resources and higher mortality. The Hospital Presumptive Eligibility (HPE) program offers emergency Medicaid for eligible patients at presentation. The HPE program underwent several changes during the Covid-19 pandemic, we quantify the program's success during this time, and seek to understand features associated with HPE approval. Material and Methods A mixed-methods study at a Level I trauma center using explanatory sequential design, including 1) a retrospective cohort analysis (2015-2021) comparing HPE approval before and after Covid-19 policy changes;2) semi-structured interviews with key stakeholders. Results 589 patients listed as self-pay or Medicaid presented after March 16, 2020, when Covid-19 policies were first implemented. Of these, 409 (69%) patients were already enrolled in Medicaid at hospitalization. Among those uninsured at arrival, 160 (89%) were screened, and 98 (61%) were approved for HPE. This marks a significant improvement in the pre-pandemic HPE approval rate (48%). In adjusted logistic regression analyses, the Covid-19 period was associated with an increased likelihood of HPE approval (vs. pre-pandemic aOR, 1.64;p = 0.005). Qualitative interviews suggest that mechanisms include state-based expansion in HPE eligibility and improvements in remote approval such as telephone/video conferencing. Conclusion The HPE program experienced an overall increased approval rate and adapted to policy changes during the pandemic, enabling more patients' access to health insurance. Ensuring that these beneficial changes remain a part of our health policy is an important aspect of improving access to health insurance for our patients.