A recent investigation into the aftermath of Medicaid “unwinding” reveals alarming interruptions in chronic medication access among children and young adults, highlighting the precarious consequences of policy shifts on vulnerable populations. This comprehensive study, spearheaded by researchers from the University of Michigan’s Susan B. Meister Child Health Evaluation and Research Center (CHEAR), meticulously analyzed prescription data to unpack a troubling trend: as states implemented disparate approaches to Medicaid eligibility verification post-pandemic, many youth experienced significant disruptions in essential drug therapies. These interruptions pose grave risks to managing conditions such as depression, schizophrenia, ADHD, asthma, and epilepsy, potentially undermining educational and occupational stability for millions.
At the heart of this research is an intense focus on the period starting April 2023, when the federal government ended temporary pandemic-era Medicaid eligibility expansions that had vastly broadened access. The so-called “unwinding” process initiated aggressive state-level purges from Medicaid rolls based on income verification and documentation updates. However, the degree to which states disenrolled individuals varied considerably, producing an uneven landscape where some areas saw dramatic enrollment drops while others maintained relatively stable coverage. This state-level heterogeneity forms a crucial backdrop to understanding the public health ramifications observed in prescription data spanning before and after the unwinding.
Using data from IQVIA’s national prescription drug database, which captures an estimated 92 percent of all dispensed prescriptions in U.S. pharmacies—including transactions paid by cash—the research team meticulously tracked how prescription-filling behavior changed among individuals aged 0 to 25. They focused on five medication classes crucial for controlling chronic behavioral, respiratory, and neurological conditions. These classes included medications for psychiatric disorders, asthma inhalers, and anti-epileptic drugs, representing the pharmacopeia vital for managing persistent and often debilitating health issues common in these age groups.
The findings reveal a disconcerting trend: young adults aged 19 to 25 residing in states with the largest adult Medicaid enrollment declines were significantly more likely to interrupt their prescription regimens compared to those in states with minimal enrollment changes. Disruptions manifested as outright cessation of prescription fills, indicating that Medicaid disenrollment reversed access to essential medicines. Moreover, in response to losing Medicaid coverage, many individuals shifted to paying for prescriptions out of pocket or switched to private insurance plans—an indicator of the financial strain and instability these disenrollments imposed. This behavioral shift further underscores systemic vulnerabilities faced by transitioning populations straddling eligibility and affordability thresholds.
Children and adolescents showed analogous, albeit somewhat less consistent, patterns. Particularly, in states experiencing enrollment drops of 17 percent or greater in Medicaid or the Children’s Health Insurance Program (CHIP), there were noticeable discontinuities in inhaler use and other chronic disease medications. Although the disruptions were somewhat more variable for younger patients, these findings still signal risks for disease control and flare-ups among pediatric populations reliant on steady medication access. CHIP recipients, defined by income too high for Medicaid but too low to afford private coverage, represent a particularly fragile demographic vulnerable to policy shifts.
This study’s implications extend well beyond retrospective documentation of unwinding’s effects. Kao-Ping Chua, the study’s lead investigator and a pediatrician at the University of Michigan Medical School, emphasizes the current relevance as policymakers debate prospective Medicaid budget cuts. The data suggest that accelerating disenrollment—even for reasons of fiscal austerity or administrative expediency—could replicate these disruptions, triggering poorer health outcomes and increased absent rates in school and workplaces. Such consequences carry profound societal costs, reducing workforce productivity and exacerbating educational inequities rooted in health disparities.
The methodological rigor of the study draws on cross-institution collaboration, combining prescription fill data with enrollment statistics from the Georgetown University Center for Children and Families. By correlating medication dispensing patterns with quantitative Medicaid disenrollment percentages, the researchers crafted a robust analytical framework that controls for confounding variables linked to local policy nuances and demographic variation. This data triangulation enhances confidence in attributing changes in therapy continuity directly to Medicaid coverage fluctuations rather than extraneous factors.
States with the greatest child enrollment declines included Arkansas, Georgia, and Texas, among others, all surpassing a 17 percent reduction threshold. Their counterparts, exhibiting less than four percent enrollment loss, featured states such as California, Connecticut, and Illinois. This stark contrast offers a natural experiment to discern policy outcome differentials, underscoring how administrative burdens and verification stringency directly influence health service continuity. The inclusion—and deliberate exclusion—of certain states, like Oregon, whose unwinding timelines diverged, further refines the comparative analysis.
Among adults aged 19 to 25, exclusions applied to three states that expanded Medicaid coverage during the unwinding, ensuring that expansion effects did not confound results. The identified states with the largest adult enrollment declines experienced drops of 19 percent or more, vividly illustrating how rollback of pandemic flexibilities destabilized coverage for young adults who are particularly dependent on Medicaid as a healthcare safety net. These enrollment losses likely reflect a convergence of policy-driven disenrollment, administrative complexity, and socioeconomic hardship.
Beyond measuring coverage gaps, the study highlights the coping mechanisms employed by affected populations. Increasing reliance on cash payments for prescriptions or shifting toward private insurance coverage signals a marked rise in out-of-pocket expenditures, threatening medication adherence for low-income individuals. This economic displacement can precipitate a vicious cycle where costs drive non-compliance, which in turn exacerbates health problems requiring more intensive—and expensive—interventions down the line.
The stakes of these findings are heightened when considering the sheer scale of Medicaid and CHIP enrollment nationwide—over 72 million Americans remain covered by Medicaid post-unwinding, with another 7.2 million children reliant on CHIP. These programs are linchpins of healthcare access for vulnerable populations, especially low-income families and young adults entering labor markets without employer-based insurance. Any policy measures that destabilize this coverage ecosystem risk reverberating through public health and social infrastructure for years to come.
Importantly, the research team includes a multidisciplinary cadre of experts from pediatrics, public health, and health economics, lending comprehensive expertise to this inquiry. Their collective backgrounds enable nuanced interpretation of complex epidemiological and policy data, bridging gaps between clinical implications and health system functioning. Funding support from prominent institutions such as the National Institutes of Health underscores the critical public health interest in rigorous, data-driven evaluation of Medicaid policy impacts.
This illuminating study serves as a stark reminder that Medicaid enrollees—especially children and young adults managing chronic diseases—depend critically on uninterrupted access to medications. Policymakers contemplating funding reductions or further tightening of eligibility requirements must weigh the human costs that extend far beyond budgetary spreadsheets. Interruptions in therapy not only jeopardize individual health trajectories but also ripple into broader social costs, including educational setbacks and diminished workforce participation. Comprehensive policy deliberations should integrate these nuanced findings to safeguard essential healthcare access for vulnerable populations.
Subject of Research: People
Article Title: Changes in Chronic Medication Dispensing to Children and Young Adults During Medicaid Unwinding
News Publication Date: 2-May-2025
Web References:
Study DOI
References:
Chua, K.-P., Constantin, J., Kenney, G.M., Conti, R.M., & Simon, K. (2025). Changes in Chronic Medication Dispensing to Children and Young Adults During Medicaid Unwinding. Pediatrics. DOI:10.1542/peds.2024-070380.
Keywords:
Young people, Adolescents, Children, Health care policy, Public policy, Depression, Psychiatric disorders, Schizophrenia, Psychosis, Anxiety disorders, Attention deficit hyperactivity disorder, Attention deficit disorder, Asthma, Epilepsy, Adults
