Medicaid-Eligible Adults Who Lack Private Coverage and Are Not Enrolled: Are They Uninsured?

Adults who are eligible for the Medicaid program but not enrolled are much more likely to face obstacles when seeking healthcare and experience worse outcomes.

The Issue

Eligible-but-unenrolled individuals utilize less healthcare, are more likely to delay care because of cost, and have higher out-of-pocket expenses when they do receive care. Researchers say the findings underscore that having health insurance promotes health and financial wellbeing.

Key Findings

• Only 37 percent of adults who are eligible for Medicaid but not enrolled in the program report having a usual source of care, compared to 69.9 percent of Medicaid enrollees and 66.8 percent of Medicaid-eligible individuals with private insurance.
• Medicaid-eligible individuals who are not enrolled in the program are significantly more likely than insured people with similar incomes to delay care because of cost (21.4% compared to 7.3% of Medicaid enrollees and 9.5% of Medicaid-eligible individuals with private insurance). 
• Compared with Medicaid enrollees, eligible but unenrolled adults were substantially less likely to have visited a doctor within the last year (23.4% compared to 65.4%), had a prescription filled (27.8% compared to 67.0%), or stayed in a hospital (2.5% compared to 12.6%).
• Uninsured Medicaid-eligible adults spent more on out-of-pocket healthcare expenses than their enrolled counterparts.

Conclusion

Researchers conclude that being eligible for Medicaid does not equate to being covered by Medicaid or private insurance, as some have suggested. People enrolled in health insurance face fewer obstacles and better outcomes. With disenrollment in Medicaid occurring nationwide as pandemic protections end, every effort needs to be made to enroll eligible people in Medicaid or other affordable coverage options.

About the Author/Grantee

The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector. Visit the Urban Institute’s Health Policy Center for more information specific to its staff and its recent research.  

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