Iowa Health and Wellness Plan COVID-19 Impacts Report

Aislinn R Conrad; Kandyce Larson; Natoshia M Askelson

doi:10.17077/rep.006600

Introduction Due to the enduring influence of the pandemic on our healthcare system and delivery of medical services in Iowa, our evaluation team investigated the impact of the pandemic on IHAWP members’ experiences with COVID-19, including economic hardship, vaccinations, treatments, hospitalizations and delays in medical care, and employment status. Having this information will provide context for IHAWP member experiences with the program and the overall findings reported in this evaluation. In addition, the information in this report can inform the public at large, including community members, public health officials, administrators, funders, and the healthcare system, about IHAWP member experiences with COVID-19. Between December 2021 and June 2022, we surveyed a stratified sample of IHAWP members selected from Medicaid eligibility and enrollment files about their experiences with the Healthy Behaviors Incentive (HBI) program that was paused during the Public Health Emergency. We oversampled underrepresented groups to ensure sufficient responses and conducted all surveys via phone after field-testing the survey in 2021. The 2,832 Medicaid members who responded reported information related to the pandemic, sociodemographic factors, social determinants of health, awareness about the HBI program, and completion of the wellness exam (AAPOR standard response rate of 22.4%). This report presents results from descriptive, bivariate, and multivariate analyses to determine associations between IHAWP member experiences with COVID-19, including vaccination, disease, treatment, and </span>hospitalization, and economic hardship, HBI program awareness and wellness exams. This research is part of an evaluation of the IHAWP being conducted by the University of Iowa Public Policy Center for the US Department of Health and Human Services, Center for Medicare and Medicaid Services at the request of the Iowa Department of Health and Human Services. Key Findings Demographics 1. Most respondents identified as White (79%), younger than 55 years old (75%), or male (57%) (Table 1). 2. Half of respondents reported employment income losses after the pandemic began (55%) (Table 2), some difficulty living on their household income (50%) or a lack of confidence in their ability to secure US$2000 to pay for unexpected expenses (44%; Table 3). 3. One in three respondents reported a high school education (34%) or full-time employment (36%), with 21 to 26% not paying a utility bill on time or having disrupted phone service since the pandemic began (Table 2). COVID-19 Vaccination 1. 68% of respondents received at least one vaccination (Figure 1). 2. More vaccinated respondents received wellness exams than respondents without at least one vaccination (72% v. 53%; Figure 8). 3. More vaccinated respondents were aware of the HBI program than respondents without at least once vaccination (74% v. 64%; Figure 7). 4. Vaccinated respondents needed less COVID-19-related medical care than non-vaccinated respondents (19% v. 25%) (Figure 9). In contrast, vaccinated respondents delayed medical care to a greater extent than non-vaccinated respondents (29% v. 22%) (Figure 10). 5. When controlling for other factors, respondents identifying as Hispanic, older, and college-educated were more likely than the reference groups to receive COVID-19 vaccinations (Tables 4, 5). COVID-19 Disease Status and Treatment 1. At the time of the survey, two in five respondents reported contracting COVID-19 (39%), with 6% reporting hospitalizations (Figure 11). 2. COVID-19 was more common among respondents identifying as Hispanic (53%), younger than 34 years old (45%), fully employed (45%) or partly college-educated (43%; Figures 12 – 14). 3. Financial insecurity was associated with COVID-19 disease and treatment: More respondents requiring treatment for COVID-19 reported financial insecurity than respondents not requiring treatment for COVID-19 (72% v. 61%; Figure 40). Medical Care Delays due to COVID-19 1. 27% of respondents delayed medical care due to the COVID-19 pandemic, with more delays reported by respondents reporting multiple race/other identities (36%), midrange ages (35-54 years old) (30%), college degrees (34%), and as female (30%), as compared to Hispanic, younger (19-34 years old), high school educated or less, and male respondents (15%, 21%, 23%, 24%, respectively; Figures 19 – 22). 2. Needing treatment for COVID-19 was more common among respondents with employment income losses (65%), food insecurity (53%), and late utility bills or disrupted phone service (44%), as compared to the other economic hardship types (Figures 25 – 27). Conclusion Overall, this study contributes knowledge about the experience of IHAWP recipients during the pandemic. Respondents faced several economic stressors, including food insecurity and employment income losses during the pandemic, which increased respondents’ needs for COVID-19 treatment and medical care delays. In contrast, the COVID-19 vaccine appeared to improve health and HBI outcomes, i.e., increased HBI awareness, more wellness exams, and less COVID-19-related medical care. Given the influence of medical care delays and economic hardship on poor health outcomes, we will investigate how medical care delays and economic hardships change over time to determine their impact on Iowans’ health in subsequent reports.

Iowa Health and Wellness Plan COVID-19 Impacts Report

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