New Study Finds Gaps in Medicaid Coverage, Barriers to Effective Asthma Management

Quality healthcare coverage is a critical component of proper asthma management. A new article authored by the American Lung Association and the U.S. Centers for Disease Control and Prevention found gaps in coverage and barriers to accessing guidelines-based asthma care in state Medicaid programs.

Published today in the Centers for Disease Control and Prevention’s (CDC’s) Preventing Chronic Disease, “Medicaid Coverage of Guidelines-Based Asthma Care Across 50 States, the District of Columbia, and Puerto Rico, 2016-2017” is the first-of-its-kind report to track asthma care coverage in Medicaid programs. The study found a lack of consistent and comprehensive coverage across states, with substantial gaps between guidelines-based asthma care and coverage by state Medicaid programs. Furthermore, the study found that barriers to care such as copays, stepped therapy and prior authorizations remain a problem in state Medicaid programs.

“Guidelines-based care is key to properly managed asthma and can improve the quality of life for millions of Americans,” said American Lung Association Chief Mission Officer Deb Brown. “Proper asthma management can be life or death for patients, and this new report finds that states can do more to provide the comprehensive and consistent care that patients with asthma need.”

Addressing these gaps and barriers would reduce asthma exacerbations, meaning less visits to the emergency room, as well as fewer missed days of school and work. Lack of coverage of asthma treatments and barriers to accessing these treatments create problems for patients to adhere to their treatment, causing poor patient outcomes and increased healthcare and productivity costs.

Asthma is a serious, chronic lung disease impacting 26.5 million Americans, including 6.1 million children. Medicaid is a substantial source of coverage for people living with asthma, with nearly half of children with asthma receiving coverage through Medicaid and the Children’s Health Insurance Plan (CHIP) (45.4 percent). Adults aged 18 to 64 years in Medicaid have asthma at a rate almost twice that of those with private insurance (13.8 percent versus 7.8 percent).

Launched in 2015, the Asthma Guidelines-Based Care Coverage Project is funded by the CDC’s National Center for Environmental Health to track asthma guidelines-based care in state Medicaid programs. Before the Project, the extent to which guidelines-based asthma care was covered by state Medicaid programs was unknown. The Project tracks coverage for seven areas of guidelines-based asthma care and nine barriers related to accessing care in Medicaid programs for all 50 states, the District of Columbia, and Puerto Rico.

“Successfully controlling asthma symptoms is critical, because when you can’t breathe nothing else matters,” Brown said. “This new report provides a better understanding of the care as well as the challenges faced by Medicaid patients with asthma, and what states can do ensure that everyone with asthma, including kids, has the opportunity to lead a healthy and full life.”

The Lung Association continues to track coverage of asthma care treatments and services to increase information available in each state and increase awareness of gaps in coverage. This data is updated annually and is available online at Lung.org/asthma-care-coverage.

With a mission to save lives by improving lung health and preventing lung disease, the American Lung Association provides best practices on asthma management for patients, caregivers, healthcare providers, communities and schools. Learn more about asthma management at Lung.org/asthma.

For journalists interested in scheduling an interview with the study’s authors or a medical or policy expert, contact Allison MacMunn at 312-801-7628 or [email protected].