Patients who experienced Medicaid lockouts were less likely to report receiving past-year medical care and more likely to report owing money for expenses, according to study results published in JAMA Network Open.

In September 2019, 5 states received Medicaid Section 1115 waivers, permitting the temporary suspension of Medicaid eligibility for patients who have failed to pay premiums. These suspensions, or “lockouts,” range from 3 to 12 months. Some patients may receive transitional medical assistance (TMA), a Medicaid designation that provides up to 1 year of coverage for families otherwise unable to afford services. Even so, the Wisconsin Section 1115 waiver permits the state to apply premiums enforced by lockouts to patients with TMA, one of Medicaid’s most vulnerable groups.

In the present analyses, investigators collected survey data in 2016 and 2018 from Wisconsin residents enrolled in TMA. Data were stratified by lockout experience; the lockout group comprised individuals in at least the second month of a lockout from TMA coverage, whereas the control group (“TMA group”) comprised patients currently enrolled in TMA. Self-reported access to care, health status, and insurance status were compared between groups using 2-sided t tests. Respondents in each group were weighted to account for differential nonresponse.

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The weighted response rates to the 2016 survey were 30.2% and 52.8% in the lockout and TMA groups, respectively. In 2018, the weighted rates were 35.8% in the lockout group and 44.1% in the TMA group. In pooled sample analyses, patients in the lockout sample (n=178) were significantly less likely than patients in the TMA group (n=711) to be older than 35 years (46.0% vs 61.9%; P <.001), and were significantly more likely to be black non-Hispanic individuals (23.7% vs 10.0%; P <.001). A greater number of patients in the lockout group reported having a high school diploma (85.2% vs 79.1%) and not living with a spouse (66.9% vs 65.2%) compared with the TMA group. In analyses adjusted for demographic characteristics, patients in the lockout group were more likely to report being uninsured (31.9% vs 18.7%; P =.01), less likely to report receiving medical care in the prior year (64.9% vs 79.4%; P =.001), and more likely to describe the quality of care received in the prior year as “fair” or “poor” (21.4% vs 8.3%; P =.001) compared with the TMA group.

In addition, patients who experienced a lockout were more likely to report owing money for medical care (63.5% vs 31.0%; P <.001) and more likely to report needing to borrow money, skip other bills, or pay other bills late to cover healthcare costs in the last 12 months (38.9% vs 20.9%; P <.001). The 2 study groups did not significantly differ in self-reports of having a usual care source, self-reported health status, or self-reported disability status.

As this was a cross-sectional survey conducted in 1 state, further study is needed to clarify the burden of Medicaid lockouts nationwide. Even so, these data suggest an unmet burden of care access among TMA enrollees who experience lockouts.


Saloner B, Dague L, Friedsam D, Voskuil K, Serna Borrero N, Burns M. Access to care among individuals who experienced Medicaid lockouts after premium nonpayment. JAMA Netw Open. 2019;2(11):e1914561