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Reform Update: Some GOP-led states contest Medicaid enrollment figures


By Virgil Dickson
Posted: March 4, 2014 - 4:15 pm ET
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A new analysis from Avalere Health estimates that between 2.4 million and 3.5 million Americans were newly enrolled in Medicaid from October through January as a result of the Patient Protection and Affordable Care Act.

The Obama administration has said that 8.9 million individuals have been determined eligible for Medicaid or the Children's Health Insurance Program through state Medicaid agencies and state-run insurance exchanges, and that another 1.2 million have been assessed Medicaid-eligible through HealthCare.gov.

But officials in the mostly Republican-led states relying on the federal HealthCare.gov insurance exchange to determine Medicaid eligibility say the number of people who have successfully enrolled in their states may only be in the tens of thousands. Elected officials in those states generally have opposed Obamacare and its Medicaid expansion.

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For example, Texas, which has the highest percentage of uninsured in the country, has processed Medicaid files for 6,703 individuals received from the federal exchange, state Medicaid officials say. Of those, only 904 have been approved and enrolled for coverage. The rest were either already on Medicaid, not eligible, or didn't complete their applications. The CMS says it has found 392,675 Texans to be eligible for Medicaid since the federal insurance exchange opened.

To reach its estimated range of Medicaid enrollment, Avalere took federal data from HHS on eligibility determinations and eliminated those thought to be previous Medicaid beneficiaries who were re-enrolling in the program. It focused on people believed to be entering into the program for the first time either because they were newly eligible or were previously eligible but had not enrolled. Avalere's estimate includes Medicaid enrollment both through the federally run and state-run exchanges. Avalere compared the number of new Medicaid and CHIP applications from October through January to the average monthly number of applications submitted from July through September of 2013 as a control.

Avalere estimated that as of Jan. 31, from 1.7 million to 2.7 million people were newly enrolled in the states that have expanded Medicaid to adults with incomes up to 138% of the federal poverty level, while 700,000 to 800,000 people were newly enrolled in the non-expansion states. The number of new enrollees in non-expansion states is somewhat surprising given that the income eligibility levels in the non-expansion states are extremely low.

Avalere did not identify which Medicaid non-expansion states were seeing the most new enrollees or the demographic characteristics of these new enrollees. But Jenna Stento, senior manager at Avalere, said it's likely that many were children, given the strong national push by the Obama administration to get lower-income children covered.

Officials in several Republican-led states relying on HealthCare.gov said they would be surprised if enrollment figures in the non-expansion states were anywhere near the 1 million mark, including both new enrollees and people re-enrolling into the program through Healthcare.gov.

State officials from Alaska, Arizona, Georgia, Michigan, Mississippi and Wyoming told Modern Healthcare they've processed very few Medicaid applications from HealthCare.gov either because they aren't receiving them yet or because they are in a testing phase during which the CMS is sending them Medicaid applications to check on the connection between the federal and state databases. They say the CMS has told them not to make eligibility determinations until the testing process is completed.

Idaho has received 6,600 full applications from the federal exchange as of the end of February, less than the 8,545 applications the CMS says it has sent. Of the applications the Idaho has actually received, 82% have been reviewed. About 43% of that group were already enrolled in Medicaid, said Tom Shanahan, a spokesman for the Idaho Department of Health and Welfare.

“Idaho is not yet getting the enrollment numbers in Medicaid that were expected, Shanahan said. “We projected about 35,000 individuals to be eligible but not covered. As of today, the only new enrollments that can be counted are the 1,900 that have come from HealthCare.gov.”

Of the 12,323 applications Oklahoma has received from the federal exchange as of March 4, 10% were from people not previously enrolled in Medicaid, far less than the 60,000 people it estimated were eligible but not enrolled. So far those people are not showing up, according to Jennie Melendez, a spokeswoman for the Oklahoma Health Care Authority.

Kansas anticipated that more than 20,000 people who previously were eligible but had not enrolled would sign up for Medicaid. But “there hasn't been a significant increase in numbers compared to this time last year,” said Miranda Steele, a spokeswoman for the Kansas Department of Health and Environment.

Maine, where the Republican governor has pushed unsuccessfully so far for expanding Medicaid, is in a testing phase of sending Medicaid enrollment data to the CMS to check the data connections. As a result, no Medicaid applications submitted from HealthCare.gov have been processed at this time, said John Martins, a spokesman for the Maine Department of Health and Human Services. “Maine has not experienced a significant increase in Medicaid enrollment as some analysts have indicated,” he said.

MoveOn effort aims to expand Medicaid

The liberal advocacy group MoveOn has launched an advertising campaign to expand Medicaid, hoping to shame Republican elected officials in non-expansion states hoping to build on the momentum of the critical shaming some Republican governors and state legislators are facing due to them blocking the expansion of Medicaid, by launching a grassroots campaign to get them to provide coverage to the poor in their state.

MoveOn members in Texas, Nebraska, Florida, Louisiana, Wisconsin, and Virginia are using billboards, petitions, and rallies to prod their elected officials to accept federal Medicaid funds for expanding Medicaid to more than two million people.

The billboards, which started appearing on March 3 and will stay up through the end of the month, list the number of state residents who are going without coverage due to the non-expansion. The billboards also incorporate elements of each state's tourism marketing campaign.

In Texas, MoveOn members funded two billboards, which state: “Welcome to Texas! Where Gov. Perry has denied 1,046,000 Texans health care and now all Texans are paying for it. It's like a whole other country.”

Expanding Medicaid could benefit 60,000 with HIV/AIDS

It's estimated that nearly 60,000 uninsured, low-income Americans with HIV/AIDS would likely get Medicaid coverage if the states they live in expanded Medicaid under the Patient Protection and Affordable Care Act, according to a Health Affairs study. More than half live in Florida, Texas and Georgia. In 2010, only 17% of people with HIV and AIDS had private insurance, compared to 65% of the general U.S. population. Nearly 115,000 uninsured, low-income people living with HIV/AIDS would be eligible for Medicaid if all states adopted the expansion, the study found.

Follow Virgil Dickson on Twitter: @MHvdickson


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