Enrolled and unaware: characteristics of Medicaid enrollees misreporting their coverage Status

Introduction: While surveys suggest that many Medicaid enrollees mistakenly report that they do not have Medicaid coverage, little is known about this population. Enrollment misreporting could be associated with poorer access if enrollees delay or avoid needed care because they incorrectly believe they cannot afford it. Methods: We exploited the COVID-19 Medicaid continuous coverage provision to identify sociodemographic and health characteristics of enrollees who initially reported Medicaid but subsequently misreported their coverage, and to characterize their patterns of health care access, utilization, and spending. Results: We found that 11.5% of enrollees misreported their coverage, belonging to 2 distinct groups: those who reported being uninsured, and those who reported other coverage. Compared to enrollees who accurately reported having Medicaid, enrollees who reported uninsurance experienced more cost-related barriers to care, lower utilization, and $1682 less in average annual health expenditures. Conclusion: These findings suggest that health care behaviors follow perceptions of Medicaid enrollment status. Because coverage confusion may impair access to needed services, addressing the needs of this group will require policy and programmatic strategies to ensure that enrolled individuals can benefit from their Medicaid coverage.