The demise of Oregon's Medically Needy program: effects of losing prescription drug coverage.

Background: In January 2003, people covered by Oregon's Medically Needy program lost benefits owing to state budget shortfalls. The Medically Needy program is a federally matched optional Medicaid program. In Oregon, this program mainly provided prescription drug benefits.

Objective: To describe the Medically Needy population and determine how benefit loss affected this population's health and prescription use.

Design: A 49-question telephone survey instrument created by the research team and administered by a research contractor.

Participants: A random sample of 1,269 eligible enrollees in Oregon's Medically Needy Program. Response rate was 35% with 439 individuals, ages 21-91 and 64% women, completing the survey.

Measurements: Demographics, health information, and medication use at the time of the survey obtained from the interview. Medication use during the program obtained from administrative data.

Results: In the 6 months after the Medically Needy program ended, 75% had skipped or stopped medications. Sixty percent of the respondents had cut back on their food budget, 47% had borrowed money, and 49% had skipped paying other bills to pay for medications. By self-report, there was no significant difference in emergency department visits, but a significant decrease in hospitalizations comparing 6 months before and after losing the program. Two-thirds of respondents rated their current health as poor or fair.

Conclusions: The Medically Needy program provided coverage for a low-income, chronically ill population. Since its termination, enrollees have decreased prescription drug use and increased financial burden. As states make program changes and Medicare Part D evolves, effects on vulnerable populations must be considered.