Purged from the Rolls: A Study of Medicaid Disenrollment in Iowa

Natoshia M. Askelson, Patrick Brady, Brad Wright, Suzanne Bentler, Elizabeth T. Momany, Peter Damiano

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Purpose: To describe the impact of disenrollment from Medicaid because of failure to pay premiums as part of Iowa's Medicaid program's personal responsibility component. Methods: We conducted a mixed method study consisting of in-depth interviews with disenrolled members in 2016 and 2017 (n=72) and a survey of disenrolled members in 2017 (n=225). Results: Many disenrollees did not know why they were disenrolled, were unaware of the personal responsibility component or premium requirement, and were confused by the disenrollment process. Disenrollment had negative effects including stress, financial burden, and engaging in behaviors such as skipping medication and postponing medical or dental care. Furthermore, disenrollees were often unable to enroll in health insurance, and for those who did, many reported it was a difficult process. Conclusions: Disenrollment had numerous, negative impacts on members who failed to pay their premiums. There was confusion about program requirements, which might indicate challenges communicating about a complicated program. Policymakers need to consider how to design and implement personal responsibility programs to achieve their desired outcome and reduce confusion and negative consequences.

Original languageEnglish (US)
Pages (from-to)637-643
Number of pages7
JournalHealth Equity
Issue number1
StatePublished - 2019
Externally publishedYes

Bibliographical note

Publisher Copyright:
© Natoshia M. Askelson et al. 2019; Published by Mary Ann Liebert, Inc.


  • evaluation
  • health insurance disenrollment
  • Medicaid


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