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Reform Update: Medicaid enrollment outpaces private plans on state exchanges


By Steven Ross Johnson
Posted: October 22, 2013 - 4:00 pm ET
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In many states around the country, the volume of Medicaid enrollment so far has surpassed the enrollment of people in private health plans through the state insurance exchanges set up by the Patient Protection and Affordable Care Act.

Much of the reported enrollment successes seen thus far in the exchanges has centered on the thousands of people who have signed up for Medicaid coverage in 2014 in the 24 states plus the District of Columbia that expanded the program to include adults earning up to 138% of the federal poverty level (Ohio just approved an expansion Monday, becoming the 25th state).

The large enrollment numbers seen by Medicaid expansion states can be attributed partly to the fact that some of those states began campaigns to identify and sign up as many qualified individuals as possible months prior to the Oct. 1 exchange launch.

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Some states have been signing people up for Medicaid through their online exchanges, while other states have instructed people to contact Medicaid offices directly to enroll.

In Washington state as of Oct. 20, 31,000 out of the more than 35,000 people who have enrolled for coverage through its online exchange have enrolled in Medicaid, said Jim Stevenson, spokesman for the state's Health Care Authority, which runs the state Medicaid program. Of those who have enrolled in Medicaid, more than 19,000 became newly eligible under the expansion, while more than 11,000 were previously eligible but hadn't signed up for Medicaid coverage.

According to Stevenson, Washington began running a marketing campaign in September to raise awareness about the health exchange. The strategy included television ads as well as outreach, with as many as 3,000 community-based volunteers trained to help with Medicaid enrollment.

“I think the outreach definitely helped,” Stevenson said. “We have about a million uninsured Washington residents, and we've only started three weeks into a campaign to get them into coverage, so there's a long way to go.”

Stevenson said the state expected Medicaid enrollment initially to be higher than private plan enrollment. But he stressed it's still early in the process and that the state expects the enrollment numbers to even out between the two programs by the time open enrollment on the exchange ends March 1, Unlike people signing up for private plan, those who qualify for Medicaid can enroll year-round

“We have 16,699 (applicants for private plans) who have gone through the [application] process but they haven't paid the money (yet),” Stevenson said. “I think there is clearly a large body of shoppers who are looking at what's available to them but not quite ready to commit.”

In Oregon, a new “fast-track” enrollment process for its Medicaid program is being credited for signing up nearly 56,000 in the first two weeks after the state exchange, Cover Oregon, opened. The state has so far not provided figures as to the number of people who have enrolled onto private plans through the exchange. Last week, Cover Oregon spokeswoman Ariane Holm said enrollment numbers would not be available until sometime in November.

Since late September, notices have been sent to as many as 260,000 residents who either are currently receiving benefits under the federal Supplemental Nutrition Assistance Program or have children enrolled in Medicaid. The notices inform them that they pre-qualified for health coverage beginning Jan. 1. The notice said they had the option to consent to enrollment by phone or by filling out a one-page form. Oregon Health Authority spokeswoman Patty Wentz said the result of the letter campaign has been a flurry of responses from people consenting to be covered.

“Our phones started ringing off the hook,” Wentz said. “Mail started pouring in, faxes started pouring in, and our call volume has been three times the normal level and it has remained strong.”

Wentz estimated as many as 75% of the state's Medicaid-eligible population qualified for fast-track enrollment. She said the mail campaign has helped to free up resources to do outreach to the remaining 25% of the eligible population.

Other states have seen similar Medicaid sign-up numbers. In Maryland, more than 82,000 people have enrolled in the state's expanded Medicaid program as of Oct. 19, compared with 2,300 estimated to have sign up for private insurance through the state exchange. In West Virginia, as many as 50,000 reportedly enrolled in Medicaid.

Maine governor expresses openness to Medicaid expansion

Maine Republican Gov. Paul LePage says he is open to a private-plan alternative for expanding Medicaid coverage to adults earning up to 138% of the federal poverty level, the Portland Press Herald Reports. According to the report, LePage, a Tea Party conservative and strong opponent of the healthcare reform law, signaled that he's willing to consider a plan similar to that which the federal government approved in Arkansas, involving using federal money to help low-income residents buy private coverage through the state insurance exchange. He credited the Obama administration for being open to creative solutions from the states. LePage previously vetoed a bill passed by the state legislature that would have expanded Medicaid under the health reform law.

Lawsuits loom in Ohio after board approves Medicaid expansion

State Republican lawmakers in Ohio are reportedly preparing to file a lawsuit over a state legislative panel's decision this week to allow federal funds allocated to the state to be used for an expansion of its Medicaid program.

Republican lawmakers have clashed with Republican Gov. John Kasich over his support for expanding Medicaid, and threatened to sue over his decision to take the matter to the state Controlling Board after months of political gridlock.

The seven-member board, composed of two Democrats, four Republicans and one member who was appointed by the governor voted 5-2 Monday in favor of expanding the state's Medicaid program, which is expected to provide healthcare for more than 275,000 low-income residents.

Follow Steven Ross Johnson on Twitter: @MHSjohnson


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