Although most individuals diagnosed with COVID-19 recover within a matter of weeks, some continue to experience long-term effects for months after they are initially infected. According to the Centers for Disease Control and Prevention (CDC), COVID-19 can exert long-term effects on multiple organ systems including the lungs, heart, kidneys, and brain. Patients may also experience lingering mental health issues even after they have recovered from their initial COVID-19 infection. Research on the persisting effects of post-COVID-19 condition (hereto referred to as “post-COVID”) is still evolving.

With funding from the Patient-Centered Outcomes Research Institute (PCORI) Engagement Award Program, AcademyHealth’s Evidence Informed State Health Policy Institute (ESHPI) explored the urgent need to build capacity for stakeholder engagement related to the effects of post-COVID and the impact of post-COVID on disproportionately affected populations. State Medicaid agencies can benefit from understanding the potential impact of post-COVID on the low-income and disabled enrollees they cover for multiple reasons. First, COVID-19 disproportionately affected low-income and marginalized populations, such as those enrolled in Medicaid, before vaccines were available. While it is still unclear whether post-COVID is more prevalent in these populations, the high prevalence of COVID-19 may have placed a greater proportion of this population at risk. Second, Medicaid enrollees are more likely to have other chronic conditions relative to the rest of the American population, which may add to their medical complexity and level of need should they experience post-COVID symptoms. Finally, post-COVID may require ongoing treatment, which would have implications for Medicaid programs in ensuring adequate access to specialty care and incurring new costs.

This research resulted in the development of a research agenda outlining essential research questions relative to assessing the impacts of post-COVID on the Medicaid population. While these questions are initially valuable for Medicaid programs and their researchers in further identifying and understanding the characteristics of post-COVID, they also serve as a pathway for the development of future patient-centered outcomes research/comparative clinical effectiveness research (PCOR/CER) questions.

This project aimed to leverage partnerships with policymakers, researchers, and other Medicaid stakeholders to identify post-COVID health policy priorities and develop the necessary research agenda to guide state-driven impact analyses. AcademyHealth’s State University Partnership Learning Network (SUPLN) researchers developed five domains of importance and in need of PCOR/CER to inform post-COVID policy in state Medicaid programs: access to care for post-COVID treatment; equity; methods; outcomes tracking; and disability. Due to the broad and complex nature of post-COVID, these five domains provide a structure with which to organize foundational research questions aimed at understanding the pandemic’s impact on Medicaid enrollees with post-COVID, including effects on access to care and equity of care.

This research agenda provides input and guidance on five domains and their respective research questions. We believe additional PCOR/CER is needed to inform Medicaid policy development in these specific areas, especially equity, methods, and disability. As states and researchers look to understand post-COVID and its impact across Medicaid subpopulations, this post-COVID Medicaid research agenda can inform PCORI and researchers on the curation of additional Medicaid PCOR/CER studies that can produce implementable strategies to improve the health of enrollees.

Read the full research agenda here.

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