Medicaid coverage tied to worse MS outcomes for US patients: Study
More relapses, disability progression seen with government medical program
Medicaid coverage for people with multiple sclerosis (MS) in the U.S. is associated with worse disease outcomes — including more clinical relapses and greater disability progression — compared with private insurance, according to a new study that investigated the impact of insurance type and socioeconomic factors on patient care.
In the U.S., Medicaid is a joint federal and state program that helps cover medical costs for certain people with limited income and resources.
Analyses found a sixfold higher risk of MS relapses, or periods when symptoms suddenly worsen or new ones appear, and a more than four times higher risk of disability progression for MS patients with Medicaid coverage versus private insurance.
“Overall, this study highlights the need for further work to characterize and address insurance and socioeconomic barriers to care for people living with MS,” the researchers wrote.
“We speculate there may be … social factors that we could not measure in this study, where Medicaid could be a proxy for social risk,” the team added.
The study, “Socioeconomic determinants of clinical outcomes in multiple sclerosis patients,” was published in the Multiple Sclerosis Journal – Experimental, Translational and Clinical.
More Black, Hispanic MS patients in study were covered by Medicaid
MS is caused by the immune system mistakenly attacking the myelin sheath, a protective coating around nerve fibers that helps them send electric signals more efficiently. Damage to the myelin sheath ultimately leads to MS symptoms like excessive fatigue, walking difficulties, and numbness and tingling.
Several factors — notably sex, race, education levels, employment status, and access to healthcare — have been previously shown to affect clinical outcomes in people with MS. However, according to the researchers, “the impact of higher DMT [disease-modifying therapies] costs, socioeconomic limitations, and insurance restrictions on MS outcomes requires further investigation.”
To learn more, the team, from Rush University Medical Center in Chicago, analyzed the medical records of MS patients treated at the facility between 2017 and 2022. The data covered 160 patients, with a mean age of 34.9. The patients were mainly women and nearly half were white individuals. Slightly fewer than one-third were Black people, with Hispanic/Latino individuals comprising nearly 20% of patients.
Among the patients, 81.4% were employed and 58.8% had a college degree or higher. Regarding health insurance, the majority (74.4%) had private insurance, while 25.6% had Medicaid coverage.
Those with Medicaid were significantly younger (31.9 vs. 36 years) and more commonly Black (43.9% vs. 26.8%) and Hispanic/Latino (26.8% vs. 15.2%) individuals than the group with private health insurance. Additionally, a higher proportion of patients with Medicaid were unemployed (30.8% vs. 2.6%) and had a higher school diploma or lower education (38.5% vs. 10.2%).
Patients with private insurance were more commonly white individuals (56.3% vs. 29.3%), employed (90.6% vs. 53.9%), and had a college degree or higher (65.9% vs. 34.6%).
Overall, the researchers noted that “there was a higher proportion of nonwhite patients in the Medicaid group compared to the private insurance group.”
The data also showed individuals on Medicaid more frequently had psychiatric conditions than did those with private insurance (46.4% vs. 23.6%).
Greater difficulties with transportation and more commonly missed appointments were seen among Medicaid patients compared with those privately insured.
Better disease outcomes seen for patients with private insurance
Regarding disease outcomes, a higher percentage of people with Medicaid coverage experienced a delay in starting on DMTs versus those with private insurance (37.1% vs. 15.1%). According to the researchers, the main reason for delays in DMT use in the Medicaid group was insurance barriers. However, after controlling for clinical, social, and other risk factors, a delay in DMT start did not differ when comparing types of insurance, the team found.
Nonetheless, patients with Medicaid were more likely to experience clinical relapses (24.4% vs. 5%) and a progression of disability (31.7% vs. 10.9%), according to the Expanded Disability Status Scale (EDSS) score at 18 months. However, both Medicaid and privately insured patients received equally effective DMTs, with similar disease outcomes regarding the appearance of new lesions detected by MRI.
“This finding indicates access to DMT did not explain observed differences in clinical outcomes among Medicaid and privately insured patients,” the researchers wrote. “Hence, we require further prospective studies to gather more detailed data about this risk over time.”
In this retrospective study, patients with MS with Medicaid had worse clinical outcomes, including more clinical relapses, and higher EDSS progression compared to privately insured patients.
Further analysis indicated that Medicaid coverage was associated with worse clinical outcomes among patients. Those on Medicaid versus private insurance had a 6.1 times higher risk of having a clinical relapse and a 4.6 times higher risk of experiencing disability progression, after adjusting for possibly confounding factors. These included patients’ age at diagnosis, race, and psychiatric conditions, as well as having missed at least one appointment or reporting transportation difficulties.
The team suggested several strategies for improving patient care.
“Implementing virtual visits, providing educational materials in multiple languages, offering transportation assistance for necessary in-person appointments, connecting patients with social work or case management services, and linking patients to health psychologists can help reduce barriers to care for marginalized populations,” the researchers wrote.
Overall, “in this retrospective study, patients with MS with Medicaid had worse clinical outcomes, including more clinical relapses, and higher EDSS progression compared to privately insured patients,” the scientists concluded.
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