Low-income Medicare beneficiaries are more likely to die if they lose access to crucial medication coverage, a new study says.

More than 14 million poor Medicare beneficiaries receive the Medicare Part D Low-Income Subsidy (LIS), which further reduces their drug costs, researchers said in background notes.

People who lose LIS eligibility are 4% more likely to die than those who keep it, researchers reported May 14 in the New England Journal of Medicine.

Risk of death is even greater among people who rely on more expensive medicines or more complex treatments, researchers noted.

For example, the death rate was 22% higher among people who rely on antiretroviral drugs to quell their HIV infection, results show. People with heart and lung conditions also had a higher risk of death if they lost the drug benefit.

“These findings show that helping low-income Medicare beneficiaries who are eligible for Medicaid stay enrolled and retain the LIS can save lives since it preserves access to essential medications,” senior researcher Dr. José Figueroa, an associate professor of health policy and management at the Harvard T.H. Chan School of Public Health, said in a news release.

Most people eligible for the LIS program — 12.5 million out of 14.2 million — are enrolled in both Medicare and Medicaid, researchers noted. The LIS program lowers their drug costs by about $6,200 a year.

People in both Medicare and Medicaid automatically qualify for the LIS. However, if a person loses Medicaid coverage, they face being cut from the low-cost drug program.

“When Medicare beneficiaries lose Medicaid, which happens to more than 900,000 people each year, they also risk losing the LIS and therefore, being able to afford the medicines they need,” lead researcher Eric Roberts, an associate professor of general internal medicine at the University of Pennsylvania Perelman School of Medicine, said in a news release.

For the study, researchers analyzed data on nearly 1 million low-income Medicare beneficiaries who lost their Medicaid coverage between 2015 and 2017.

Researchers found that people who dropped out of the LIS program died at a higher rate than those who stayed within the program for a handful of additional months.

Worse, more than half of the people who lost their Medicaid eligibility regained it within a year, suggesting that many were dropped due to a paperwork snafu or bureaucratic error, researchers said.

This impact on people’s health could have grown post-pandemic, as states have started a concerted effort to prune their Medicaid rolls, researchers said.

During the COVID-19 pandemic, states were not allowed to drop people from Medicaid rolls, but states have since started going through their rolls to remove the ineligible, an effort called “Medicaid unwinding.”

“As policymakers consider major changes to the Medicaid program, preserving Medicaid coverage for older adults is critical to ensuring that they keep the LIS,” Roberts noted.