As advisers to campus health administrators across the country, we hear this story a lot: A college student who is covered by Medicaid waives their school’s student health insurance plan (SHIP). They already have insurance, they say. Why would they need different coverage? But the problem is they go to school out of state—and their Medicaid only covers them at home.
While this student’s Medicaid would kick in to cover care in life-threatening emergencies, and their campus health center might offer things like routine tests and vaccines free of charge, they’ll be left underinsured for everything in between.
As pandemic-era expansions to Medicaid benefits have expired nationwide—further complicating an already tricky issue—we know college students, their families, and campus administrators alike are experiencing uncertainty and confusion as they try to understand how to prevent gaps in health care coverage for those away at college. So we’re diving in and exploring what to know and consider when it comes to students and out-of-state Medicaid coverage.
In general, Medicaid benefits can’t be used out-of-state
Because every state sets its own Medicaid eligibility requirements, you can’t use your benefits when you’re out of state, whether you’re visiting temporarily or, as is the case for many college students, living there temporarily. There are a few exceptions, the most prevalent being that Medicaid will cover out-of-state care in emergencies, but only in life-threatening situations where returning to one’s home state for treatment is not possible. Some states will cover care within a defined out-of-state radius (say, within 90 miles), but often there are additional stipulations attached to care as well.
Medicaid coverage cannot be transferred from state to state, either. If a college student is covered by Medicaid at home and wants to maintain that coverage while away at school, they’d need to apply for benefits in the state where they’re relocating. To do that, however, they’d first be required to terminate their existing coverage, as people cannot receive Medicaid benefits from two states at once. This presents its own set of challenges.
Student health insurance guarantees students can access the care they need while away at school
It’s no surprise that being covered by health insurance has a positive impact on a student’s health and well-being. Having health insurance is generally associated with better health—and healthy students are less likely to miss classes and fall behind on schoolwork, which promotes a more successful academic experience.
In a study by the City University of New York, researchers found that 13.5 percent of undergraduates reported a health problem had interfered with their school work, and that students with one or more chronic conditions were more likely to have a GPA of less than 2.5 or to have failed out of a degree or program.
Mental health conditions, especially, have become hugely prevalent on college campuses and are proving to be a barrier to academic success. In 2022, 77% percent of college students experienced moderate to serious psychological distress, including 35% who were diagnosed with anxiety and 27% suffering from depression. One study found as many as 83% of students said mental health difficulties affect their academic performance. Addressing mental health conditions is critical to ensuring the health and safety of students. Without treatment, college students are more likely to drop out, suffer from substance abuse, and die by suicide.
Fortunately, many higher education institutions across the country offer a student health insurance plan (SHIP) to their students. These plans are specifically designed with students in mind, offering comprehensive medical coverage through a national network.
For out-of-state students, who are often in need of more localized coverage, they provide access to a reliable network of area providers, a comfort and convenience to students as they learn to navigate life away from home for the first time.
Still, many students who are covered by Medicaid choose to opt out of their university’s SHIP, despite not being able to access their benefits in their new state. Why? Several factors could be at play.
1. Fear of losing existing coverage:
In some cases, students who opt into a private insurance plan (like a university’s SHIP) would lose their primary Medicaid coverage as a result. This can be concerning to students and their parents, who may wonder how they’ll access coverage while home during school breaks. However, many SHIPs can be used nationwide, and in some cases internationally, which would make them reliable coverage options for students no matter where they are.
While Medicaid is subsidized by the state, SHIPs are private insurance plans that require a premium and are often associated with additional out-of-pocket expenses. While the cost of any insurance plan is significantly less expensive than accessing health care without coverage, the cost of a SHIP might be too big a financial burden for families covered by Medicaid. Some universities offer loans to help students pay for the insurance premium.
Not fully understanding a school’s student health insurance plan and its benefits could be another reason families choose to opt out. Campus health administrators might consider ways to prioritize clarity and transparency when educating students on their coverage options and communicating the limitations to opting out in favor of out-of-state Medicaid.
Requiring students to take the SHIP is an option—but it has its drawbacks
One way for university administrators to ensure every student has adequate health insurance coverage is to mandate that all students with out-of-state Medicaid opt in to the student health insurance plan. While this guarantees these students will have access to local, in-network healthcare providers, it often means they’ll lose their Medicaid coverage at home, as we’ve outlined above. Offering a student plan that provides nationwide coverage, such as a PPO, is one way to curb this complication by sending students away for the summer with coverage that will follow them home.
Addressing the cost prohibitors may take some financial finagling
In addition to providing loans to help students cover the student health insurance plan premium, some colleges and universities choose to wrap that cost into the cost of enrollment fees. Enrollment fees are included in the cost of attendance—and financial aid covers the cost of attendance. Since many students on Medicaid receive various forms of financial aid, structuring health insurance costs in this way might help mitigate financial barriers.
When students waive their school’s student health insurance plan in favor of out-of-state Medicaid, it leaves them at risk of being underinsured, less likely to manage health conditions, and more likely to incur medical-related debt. Ensuring students have access to primary care, mental health care, and other specialty care when they need it is a critical part of supporting their academic experience as well as their overall health and well-being. An experienced partner like HUB|HORAN Campus Health Solutions can help you navigate unique challenges and develop effective strategies to promote student health on your campus.
At HUB|HORAN Campus Health Solutions, we champion bold innovations and offer customized health plans, resources, and tools designed to improve the overall health and well-being of your students. Together, we can offer the holistic support students need to thrive on campus and succeed in life.
To get started, visit our Campus Health webpage to fill out a simple contact form or get in touch with Phillip Arrington, Vice President of HUB|HORAN Campus Health Solutions, at PhillipA@horanassoc.com.