Medicaid Unwinding Linked to Smaller Prescription Shifts Than Enrollment

Medicaid enrollment and reimbursed prescription volume moved in the same general direction during continuous enrollment and the subsequent unwinding period, though prescription changes were smaller. Investigators examined whether shifts in coverage were accompanied by similar movement in reimbursed prescriptions as protections began and later ended. Their analysis spanned the period before the policy change, the years with continuous enrollment, and the months after redeterminations resumed. This approach linked major coverage transitions with statewide trends in reimbursed medications over the study period. Overall, enrollment and prescriptions followed a parallel pattern, with less pronounced movement in prescriptions.

The study used a cross-sectional design with interrupted time series analysis and log-transformed linear regression. Researchers tracked quarterly Medicaid enrollment and estimated reimbursed prescriptions from 2018 Q1 through 2024 Q1. They defined 2020 Q2 as the start of continuous enrollment and 2023 Q2 as the start of unwinding. The main outcomes were quarterly enrollment and the estimated number of reimbursed prescriptions. This framework supported direct comparison of quarterly trajectories across the two policy periods.

Medicaid enrollment rose 2.42% per quarter (95% CI, 2.15% to 2.70%) during continuous enrollment and then fell 4.92% per quarter (95% CI, −6.12% to −3.70%) during unwinding. Over the same intervals, estimated reimbursed prescriptions increased 1.85% per quarter (95% CI, 1.21% to 2.50%) and then decreased 3.94% per quarter (95% CI, −5.73% to −2.11%). Both enrollment and prescription volume peaked in 2023 Q2 and declined afterward. Prescription volume tracked enrollment directionally across both phases of policy change. The shifts were parallel across outcomes, though not equal in size.

The authors also describe similar directional patterns for medications used to treat chronic diseases and for pediatric-specific formulations. They further report that chronic disease medication declines were larger in states with the highest disenrollment during unwinding. States that used more protective policies during unwinding had smaller decreases in enrollment and insignificant decreases in chronic disease medication use. These differences were presented as state-level contrasts rather than as separate causal estimates. The subgroup findings therefore focused on reported variation across state policy contexts.

The investigators conclude that medication-use changes during continuous enrollment and unwinding were measurable, yet remained smaller than enrollment changes. They also report that policies described as protective were associated with mitigation of those shifts. The findings are framed as an observational account of prescription patterns during coverage transitions, rather than as a directive for policy choices. This interpretation keeps the emphasis on reported associations between enrollment change and reimbursed medication use. Overall, the study links coverage turnover with parallel but more modest prescription shifts.

Key Takeaways

• Quarterly Medicaid enrollment and reimbursed prescriptions changed in parallel during continuous enrollment and unwinding, with smaller prescription shifts.
• Similar directional patterns were reported for chronic disease medications and pediatric-specific formulations.
• Larger chronic medication declines were observed in high-disenrollment states, while smaller changes were reported where more protective policies were used.