Medicaid: out-of-pocket expenses and access to care.

Over the past few years, several states have increased or begun charging out-of-pocket expenses for Medicaid, State Children's Health Insurance Program (SCHIP), and other public health programs that help many Americans without private health insurance pay for medical care and treatment. On May 27, the Kaiser Family Foundation's Commission on Medicaid and the Uninsured released "Increasing Premiums and Cost Sharing in Medicaid and SCHIP: Recent State Experiences," a report on how increased premiums and cost-sharing affect the ability of people with low incomes to keep their Medicaid and SCHIP coverage.

Kaiser's Samantha Artiga and Molly O'Malley examined 13 studies done in seven states from 2001 to 2005. Oregon provided a striking example of lost access to care: In 2003, the state increased Medicaid premiums for poor adults to between $6 and $20 and eliminated waivers for the homeless. Enrollment dropped by roughly 50,000 people--almost hall of those on Medicaid. Sixty-seven percent of those dropped from the rolls became uninsured after that, and Oregon recorded an increase in emergency-room use by uninsured patients, as well as increased pressure on clinics.

The 27-page report can be found online at http://www.kff.org/medicaid/7322.cfm or by requesting publication number 7322 from the Kaiser Commission on Medicaid and the Uninsured at 202.347.5270 or 1330 G Street, NW, Washington, DC 20005.