Medicaid Unwinding Linked to Disrupted Chronic Medication Therapy in Youth

New research reported that Medicaid unwinding during the COVID-19 pandemic disrupted chronic medication therapy in young adults.1

During the pandemic, Congress required states to maintain enrollment of nearly all Medicaid enrollees, referred to as the “continuous enrollment condition.”2 The condition concluded on March 31, 2023. The “Medicaid unwinding” varied across states based on how many people they disenrolled, administrative processes, and efforts to verify income-based eligibility.

A new study, led by Kao-Ping Chua, MD, PhD, from the Susan B. Meister Child Health Evaluation and Research Center at the University of Michigan Medical School, sought to examine whether this “Medicaid unwinding” disrupted chronic medication therapy in young patients.1

Medications can bring great relief for young adults dealing with depression, schizophrenia, ADHD, asthma, and epilepsy—but only when taken regularly. Medication interruptions can lead to flare-ups of chronic health conditions, so investigators wanted to study the impact of medication interruption on treatment outcomes.

Chua and colleagues conducted a difference-in-differences analysis of the 2017 – 2023 IQVIA Longitudinal Prescription Database, which captures 92% of prescriptions filled in US pharmacies. They also used data from Georgetown University Center for Children and Families to calculate the percentage change in child enrollment in Medicaid and CHIP from before the start of the unwinding to the end of 2023.

The team looked for the number of days with active prescriptions, no prescriptions, and≥ 1 cash-pay prescription in quarters 3 and 4. Investigators also compared changes between 2017 and 2022 and 2023 among states in the top vs bottom quartile of the percent reduction in Medicaid enrollment.

The study included Medicaid-insured children aged 0 – 18 years and young adults aged 19 – 25 years who used 5 chronic medication classes from quarter 1 of 2017 to 2023: attention-deficit/hyperactivity disorder medications, antidepressants, antiepileptics, antipsychotics, and inhaled steroids. Sample sizes ranged between 226,311 and 4,683,451 person-years.

The research revealed living in a state experiencing high Medicaid enrollment loss was linked to a reduction in active prescriptions. For children, living in a state with high Medicaid enrollment losses was linked to a larger drop in days with active prescriptions for 1 medication class and a greater increase in the risk of having cash-pay prescriptions for 3 classes.

States with the largest drops in child Medicaid enrollment (≥ 17%) were Arkansas, Georgia, Iowa, Idaho, Kansas, Montana, New Hampshire, Oklahoma, South Dakota, Texas, Utah, Wisconsin, and West Virginia. States with the smallest drops (≤ 4%) were California, Connecticut, District of Columbia, Hawaii, Illinois, Kentucky, Maryland, Maine, North Carolina, Nevada, New York, Rhode Island, and Tennessee.

Similarly, among young adults, living in a state with high Medicaid enrollment losses was associated with a greater reduction in days with active prescriptions for 2 medication classes and a greater increase in the risk of having no prescriptions and cash-pay prescriptions for all classes. States with the largest drops in adult Medicaid enrollment (≥ 19%) were Arkansas, Colorado, Idaho, Kansas, Montana, New Hampshire, North Dakota, Oklahoma, Texas, Utah, West Virginia, Wyoming; states with the lowest drops (≤ 8%) were California, Connecticut, Delaware, Hawaii, Illinois, Maine, Massachusetts, Minnesota, Nebraska, Nevada, Virginia, and Wisconsin.

Both children and adults were more likely to start using cash or private insurance to pay for prescriptions if they lived in states with high Medicaid enrollment drops. At the end of the unwinding, nearly 72 million Americans remained enrolled in Medicaid, and 7.2 million children were enrolled in CHIP, which relies on Medicaid funding.

“Our findings suggest that the rapid disenrollment of young people from Medicaid during the unwinding process resulted in the disruption of chronic disease therapy,” Chua said in a statement.3 “As policymakers debate whether to enact drastic cuts to Medicaid funding, they should consider the possibility that doing so could similarly disrupt chronic disease therapy for children and young adults, placing them at higher risk for disease exacerbations and absenteeism from school and work.”

References

1. Chua KP, Constantin J, Kenney GM, Conti RM, Simon K. Changes in Chronic Medication Dispensing to Children and Young Adults During Medicaid Unwinding. Pediatrics. 2025 May 2:e2024070380. doi: 10.1542/peds.2024-070380. Epub ahead of print. PMID: 40314398.

2. ARCHIVED: Unwinding and Returning to Regular Operations after COVID-19. Medicaid.gov. https://www.medicaid.gov/resources-for-states/coronavirus-disease-2019-covid-19/unwinding-and-returning-regular-operations-after-covid-19#:~:text=As%20part%20of%20the%20COVID,SHOs%2C%20CIBs%2C%20and%20FAQs. Accessed May 6, 2025.

3. Medicaid Unwinding Disrupted Kids’ and Young Adults’ Access to Chronic Disease Medicine. News Wise. April 30, 2025. https://www.newswise.com/articles/medicaid-unwinding-disrupted-kids-and-young-adults-access-to-chronic-disease-medicine. Accessed May 6, 2025.