Medical Student Investigates Racial and Ethnic Disparities in Medicaid Disenrollment

Kranti Rumalla, a second-year medical student at Feinberg, was the lead author of a first-of-its-kind study published in JAMA Internal Medicine which found racial disparities among patients who were disenrolled from Medicaid after the end of the COVID-19 Public Health Emergency. 

Originally from Ocala, Fla., Rumalla earned his bachelor’s degree in legal studies and public health at Northwestern and matriculated into the Feinberg through the Northwestern Honors Program in Medical Education (HPME).

Read a Q&A with Rumalla below.

Why did you want to pursue medicine as a career?

I believe both medicine and healthcare are so important and integral to people’s lives. A slight change in the healthcare system, like a better patient-doctor interaction or surgical technique, can have profound impact beyond just that one clinic visit. That’s something I wanted to contribute to and be a part of. As a legal studies and a global health major in undergrad, I learned to view medicine from a broader, societal perspective.

What are your current research and clinical interests?

My clinical interests are in the surgical specialties. My research interests include healthcare policy, quality improvement, and improving outcomes for marginalized populations.

Tell me more about your recent study. What was the motivation behind it and what were your findings?

During my gap year between undergrad and medical school, I interned with a Medicaid research agency. After the internship, I was left with several questions about Medicaid enrollment that I wanted to explore. One key issue was the disenrollment crisis. During the COVID-19 pandemic, people who had been on Medicaid due to the public health emergency weren’t being redetermined – the renewal process was paused, and people were kept on Medicaid because of the emergency. As a result, we saw the highest percentage of Medicaid coverage the U.S. has ever had.

 As the public health emergency ended, each state had to determine whether Medicaid enrollees were still eligible. In the end, 22 million people were disenrolled, many of whom were actually eligible but faced difficulties in completing the renewal process.

We found that Black and Latinx individuals were approximately twice as likely as white individuals to report losing Medicaid coverage because of difficulties in completing the renewal process. This was also self-reported race and ethnicity data, which I believe is more reliable because it’s not someone else classifying you. That’s your experience. Race and ethnicity categories also have limitations, but we thought it was important to highlight this issue so that policy solutions could be discussed.

What do those policy solutions look like to you?

There are so many things that can be done. We proposed those that are the easiest to implement but will make the most impact. One solution is to hold off on processing people whose eligibility is unclear and move them to the back of the line. That would give people time to, for example, change their address or pull their tax information so they can send it on time and complete their applications.

Another potential solution is for states to keep people continuously enrolled for longer periods of time. Another is providing more resources for administrative processes and renewal assistance. People should be able to access the Medicaid website in a variety of languages, however more than half of U.S. states offer their Medicaid website only in English. Medicaid is also a primary health insurer for children in the U.S., so certain states, like Texas and Florida, have disenrolled millions of children and haven’t given them any preferential treatment.

What advice would you give to prospective medical students?

There are so many ways to learn medicine and help people as a medical student and doctor. Explore different areas of medicine as much as possible and find what resonates with you the most. Also, if you don’t see people like yourself making decisions in the healthcare system, that means medicine needs you the most. One of the lessons I learned from this study is that the people making these policies may not even know anyone who’s had to apply for Medicaid, so they might not understand just how complex the process is and the devastating effects of losing coverage.