Evaluation of the Association of Medicaid Continuous Eligibility on Hospital Charity Care

The New Jersey Hospital Care Payment Assistance Program (Charity Care) provides free and reduced-cost care to uninsured and underinsured individuals. Medicaid coverage reduces hospital charity care costs, yet gaps in eligibility can increase charity care costs. This project examines the impact of New Jersey’s 12-month continuous Medicaid eligibility expansion, authorized under a Section 1115 waiver, on hospital charity care expenses for two populations: postpartum women and nonelderly adults eligible based on the Modified Adjusted Gross Income (MAGI) standard. 

Using linked 2017–2023 New Jersey Hospital Discharge Data and Charity Care data, we will measure hospital charity care costs through three approaches: Medicaid-equivalent charges, actual discounted payments, and hospital-specific cost estimates. Analyses will compare costs across three policy periods: baseline, pre-Public health Emergency (PHE) (2017–Feb 2020), PHE and Medicaid eligibility “unwinding” (March 2020–June 2024), and the post-PHE demonstration period. We compare trends in charity care costs as well we apply regression analysis to analyze these trends. Sensitivity analyses will adjust for patient socio-economic status using ZIP code–level data.  The proposed research strategy has been reviewed and approved by the NJ Division of Medical Assistance and Health Services (DMAHS) and the U.S. Centers for Medicare and Medicaid Services (CMS). 

The study will provide evidence on how continuous Medicaid eligibility affects charity care costs. Findings will inform state and federal policymakers and will be reported to the DMAHS and CMS via interim and summative evaluation reports. Findings will also be submitted for peer-reviewed publication.