Evidence Use in Medicaid: Understanding the Impact of Long COVID on Vulnerable Populations

Background: In the United States, the COVID-19 pandemic has taken more than 640,000 lives (as of September 15, 2021) and further exposed inequities across communities where many have faced greater long-term risks due to socioeconomic factors. Most individuals diagnosed with COVID-19 recover within a matter of weeks, but some individuals continue to experience long-term effects for months after they are initially infected. The economic impact of the pandemic has caused increases in Medicaid enrollment across the country, and Medicaid has served as the primary payer for many individuals diagnosed with COVID-19. With significantly low vaccination rates among vulnerable Medicaid populations, state Medicaid agencies are confronted with assessing the burden of long-term effects of post-acute COVID-19 or “long COVID.” 

Proposed Solution to the Problem: AcademyHealth’s State-University Partnership Learning Network (SUPLN) is well positioned to assist with this pressing challenge. SUPLN consists of 30 Medicaid agency and public university researcher partnerships in 28 states and serves to extend the use of evidence in state health policy making. SUPLN also helps facilitate the Medicaid Outcomes Distributed Research Network (MODRN), a subset of 13 SUPLN partnerships representing almost 17.8 million (24 percent) Medicaid enrollees. MODRN works collaboratively with SUPLN to develop standard Medicaid analyses to inform critical Medicaid policy decisions. Together, SUPLN, with MODRN’s analytic expertise, is well positioned to identify, prioritize, and support the analysis of critical research questions related to the impacts of long COVID among Medicaid beneficiaries. This collaboration will assist Medicaid policy makers and researchers with identifying high-priority and feasible research questions and will also equip them with necessary tools to analyze those research questions of interest. Ultimately, this project will improve the ability of Medicaid agencies to characterize and respond to the impacts of long COVID among their beneficiaries. 

Objectives and Activities: The primary objective of this project is to assist Medicaid policy makers and researchers with identifying and prioritizing PCOR/CER questions related to long COVID, as well as developing an action-oriented research toolkit to support analyses of those research questions. Once developed, this research agenda and toolkit will allow Medicaid researchers and policy makers to more effectively characterize and respond to emerging issues related to long COVID. 

Projected Outcomes and Outputs: The work described here will have significant medium-term and long-term impacts following the project period. In the two years immediately following the project period, this work will allow Medicaid policy makers to better understand and respond to the effects of long COVID. Perhaps most importantly, Medicaid beneficiaries experiencing long COVID will ultimately experience better health outcomes as Medicaid agencies are better equipped to understand and respond to these conditions. Further, through the use of collaborative, cross-state partnerships and the development of a prioritization process and research agenda pipeline, this project will lay the foundation for future long-term research collaborations between Medicaid agencies and their research partners. 

Patient and Stakeholder Engagement Plan: This project will engage Medicaid stakeholders among the MODRN, SUPLN, and MMDN to identify and prioritize novel PCOR/CER topics related to the long-term effects of post-acute COVID-19.