A new study published in the New England Journal of Medicine reveals that low-income Medicare beneficiaries who lose access to prescription drug subsidies face significantly higher mortality rates, highlighting the critical role of medication affordability in health outcomes.
Researchers from the University of Pennsylvania and Harvard T.H. Chan School of Public Health found that individuals who lost the Medicare Part D Low-Income Subsidy (LIS) after being disenrolled from Medicaid were 4% more likely to die compared to those who maintained coverage.
Impact on Vulnerable Populations
The mortality risk was particularly pronounced among patients with complex or expensive medication needs. HIV patients who lost coverage faced a staggering 22% higher death rate. Similarly, individuals with cardiovascular disease and chronic lung conditions experienced substantially elevated mortality risks after losing their subsidies.
"These findings show that helping low-income Medicare beneficiaries who are eligible for Medicaid stay enrolled and retain the LIS can save lives since it preserves access to essential medications," said senior researcher Dr. José Figueroa, associate professor of health policy and management at Harvard.
Financial Burden Without Subsidies
The LIS program provides crucial financial relief, reducing prescription drug costs by approximately $6,200 annually for eligible beneficiaries. Currently, more than 14 million low-income Medicare recipients benefit from this program, with 12.5 million qualifying through dual Medicare-Medicaid enrollment.
"When Medicare beneficiaries lose Medicaid, which happens to more than 900,000 people each year, they also risk losing the LIS and therefore, being able to afford the medicines they need," explained lead researcher Eric Roberts, associate professor of general internal medicine at the University of Pennsylvania Perelman School of Medicine.
Study Methodology and Findings
The research team analyzed data from nearly 1 million low-income Medicare beneficiaries who lost Medicaid coverage between 2015 and 2023. They compared mortality rates between those who disenrolled from Medicaid in the first half of the year (early disenrollment) versus those who disenrolled in the second half (late disenrollment).
At 17 months post-disenrollment, the cumulative mortality was higher among early disenrollees (78.3 per 1,000) compared to late disenrollees (75.3 per 1,000), representing a difference of 3.0 deaths per 1,000 beneficiaries. This mortality gap widened to 5.6 deaths per 1,000 among those with the highest baseline Part D spending.
Administrative Barriers to Continuous Coverage
Concerningly, the researchers discovered that more than half of individuals who lost Medicaid eligibility regained it within a year. This pattern suggests that many beneficiaries were disenrolled due to administrative or paperwork issues rather than actual ineligibility.
The study's findings take on added significance in the context of post-pandemic "Medicaid unwinding," as states review and potentially remove beneficiaries from their Medicaid rolls after the COVID-19 continuous enrollment requirement ended.
Policy Implications
The researchers emphasize that maintaining continuous coverage for vulnerable populations is not merely a matter of administrative efficiency but a life-saving necessity.
"As policymakers consider major changes to the Medicaid program, preserving Medicaid coverage for older adults is critical to ensuring that they keep the LIS," Roberts noted.
The study concludes that efforts to increase continuous Medicaid and LIS coverage could help protect the health of low-income populations by ensuring access to affordable medications. These findings underscore the profound health consequences that can result from coverage disruptions and highlight the need for policy solutions that prioritize continuous access to essential medications for vulnerable populations.
