NM CLP in the News "States see high interest in Medicaid coverage"

States see high interest in Medicaid coverage

By Jennifer Haberkorn

10/28/13 6:05 PM EDT

HealthCare.gov might be limping along to full viability, but Medicaid is flying off the shelves.
New Medicaid enrollment is far outpacing new insurance customers under Obamacare so far, a subtle sign that the program could play a greater role in the law’s coverage expansion than first anticipated. Some people are signing up for the Medicaid expansion created by the president’s health law. Others were already eligible for their state’s current Medicaid program but until this outreach campaign about health coverage they had never signed up.

In Washington state, for instance, the overwhelming number of people signing up for health coverage are eligible for Medicaid, state figures show. Of the 35,528 state residents who had signed up in the first three weeks of enrollment, 55 percent were part of the Medicaid expansion population, and 32 percent were eligible for the state’s existing Medicaid program. Only 13 percent signed up for a new private insurance plan.

In Kentucky, another state running its own exchange, 26,174 people had enrolled in new coverage as of Thursday. Four out of five had enrolled in Medicaid.

So far, only a few states have released enrollment figures. And the federal government doesn’t plan to put out figures for the 36 states where they are running the exchanges until next month. But the figures in a few states could be emblematic of a national trend.

There are several reasons for the spurt of Medicaid coverage, much of which health policy experts had expected.

Health officials were always expecting the massive media attention on Obamacare to spur people who were eligible for Medicaid but not enrolled to sign up — a phenomenon dubbed the “woodwork” effort (as in crawling out of the woodwork), or the friendlier term “welcome mat” effect. For those people, coverage could start as soon as the state approves the application. For expanded Medicaid and the private health insurance plans on the exchange, the start date for coverage is Jan. 1.

New Mexico just put its Medicaid application online as part of the expansion, and that’s made the sign-up process easier for some people.

“The big change for us is that we now have an online application for Medicaid,” said Sovereign Hager, a staff attorney at the New Mexico Center on Law and Poverty. She’s personally helped about five or six people through the sign-up process but hasn’t heard of many people in New Mexico getting through the troubled federal HealthCare.gov.

Medicaid also doesn’t have a premium — and is the only option for people who are eligible. Customers shopping for private plans onHealthCare.gov — if they can get through — likely have multiple plans to choose from. And they have premiums to pay in nearly all cases, even if they get federal subsidies.

“This is not really a surprise, but free is easier to sell than low-cost — and Medicaid enrollment is free,” said Alan Weil, executive director of the National Academy for State Health Policy. “It’s a lot easier to close the deal if at the end of the process, you can offer someone a product without a premium — even if the exchange premium is highly subsidized.”

The Medicaid population — even the Medicaid expansion population — is also a known entity in most states. Many people who will be eligible for the Medicaid expansion are already enrolled in other state safety net programs, or charity-care programs at hospitals. That means their contact information is likely already in a database — and many institutions have already sent information about how to enroll in Medicaid.

Medicaid, while booming in some areas, isn’t without its own enrollment troubles.
The 36 states using the federal insurance exchange won’t begin receiving Medicaid applications on Nov. 1, according to the National Association of Medicaid Directors. After one earlier delay, the exchange was supposed to start sending the data this week, but technical problems forced another indefinite delay.

“The agency is now prepared to start testing this function with any state Medicaid agency that is ready,” the group’s weekly report said, “but did not give a new target date for transfers to begin.”
The delay could further complicate the enrollment process because many states are allowed 45 days to review applications before determining eligibility.

Kyle Cheney contributed to this report.

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