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Session Submission Type: Panel
Public insurance programs like Medicare and Medicaid are essential for expanding coverage to low-income, disabled, and aging populations. Yet, as these programs evolve through policy changes and regulatory reforms, new challenges in ensuring equitable access to care have emerged. This panel presents four empirical studies examining how federal and state policies influence coverage, provider access, and equity in Medicare Advantage (MA) and Medicaid, with a focus on impacts for vulnerable populations and market responses.
The first paper, ESKD MA Expansion and Impacts on MA Market, Premiums, and Benefits (Cai et al.), evaluates the effects of the 21st Century Cures Act, which expanded MA eligibility to end-stage kidney disease (ESKD) patients. Using a difference-in-differences approach across nearly 3,000 counties, the study finds that areas with higher ESKD incidence experienced increased MA plan premiums following the policy. These changes may strain access and affordability for beneficiaries in high-ESKD regions, with disproportionate implications for Black and Hispanic populations heavily represented in the MA program. The findings suggest a need for targeted policy responses in regions bearing greater cost burdens from risk pool shifts.
The second paper, Barriers to Enrollment, Procedural Denials, and Loss of Medicaid Coverage (Myerson et al.), presents results from a randomized controlled trial evaluating the effectiveness of targeted outreach to individuals who lost Medicaid coverage for procedural reasons. The study tests whether live or prerecorded calls from health insurance Navigators increase the likelihood of successful Medicaid renewal. Early evidence suggests that personalized outreach—especially among underserved populations such as non-English speakers, tribal members, and racial minorities—can significantly reduce coverage gaps. These findings offer actionable insights for state and federal programs aiming to minimize churn and improve continuity of care.
The third paper, The Effect of Network Adequacy Standards: Evidence from Medicare Advantage (Lavallee et al.), investigates the effectiveness of CMS’s network adequacy regulations in ensuring sufficient provider access in MA plans. Leveraging regulatory discontinuities across county classifications and using a regression discontinuity design, the study finds that stricter network adequacy standards do not significantly increase the number of contracted providers across specialties. This raises concerns about the limits of current regulatory tools and suggests alternative strategies may be needed to improve provider access in MA—particularly given the growing reliance on restricted networks.
The final paper, When What You See Isn’t What You Get: Ghost Networks in Medicare Advantage (Hamer et al.), analyzes discrepancies between advertised and actual provider availability in MA primary care networks. Using linked administrative and billing data, the authors identify “ghost networks” in which a substantial share of listed providers deliver few or no services. These networks are more prevalent in plans serving distressed communities and non-White populations, raising concerns about transparency, access, and equity.
Together, these studies shed light on how public insurance programs can fall short of delivering meaningful access—even when coverage is expanded. They underscore the importance of not only expanding eligibility but also strengthening oversight, outreach, and transparency to ensure access to care is real, equitable, and effective.
Impact of Medicare Advantage Expansion on End-Stage Renal Disease: Premiums and Market Dynamics - Presenting Author: Sih-Ting Cai, Indiana University; Non-Presenting Co-Author: Grace Ann McCormack, University of Southern California; Non-Presenting Co-Author: Hansoo Ko, George Mason University
Impact of Outreach on Medicaid Coverage Outcomes for People with Procedural Denials - Presenting Author: Rebecca Myerson, Emory University; Non-Presenting Co-Author: Laura Dague, Texas A&M University
The Effect of Network Adequacy Regulation on MA Networks - Non-Presenting Co-Author: Kelly E Anderson, University of Colorado Denver; Presenting Author: Matthew Lavallee, Johns Hopkins University; Non-Presenting Co-Author: David M Anderson, University of South Carolina; Non-Presenting Co-Author: Sih-Ting Cai, Indiana University; Non-Presenting Co-Author: Mark Katz Meiselbach, Johns Hopkins University
What you see isn’t what you get: Prevalence and Exposure to Ghost Networks in Medicare Advantage - Presenting Author: Mika Hamer, University of Maryland, College Park; Non-Presenting Co-Author: Rachel Smith, University of Maryland