Observers say this is partly because some of those states began campaigns early on to identify qualified individuals and ease enrollment months prior to the Oct. 1 exchange launch. Another factor is that unlike private plan enrollment, people signing up for Medicaid don't have to pay anything out of pocket for premiums, and enrollment and eligibility determination are simpler.
In contrast, people applying for private plans are likely to shop around for a plan and wait until closer to the Dec. 15 cut-off date for coverage starting Jan. 1 before paying their premium and formally enrolling, said Stan Dorn, a senior fellow at the Urban Institute. State exchange officials say the higher number of applications for private coverage compared with completed enrollments suggests there will be a spike in enrollment in December.
Some states are signing up people for Medicaid through their online exchanges, while others have set up separate enrollment processes. The Patient Protection and Affordable Care Act allows states to expand Medicaid coverage to adults earning up to 138% of the federal poverty level.
Medicaid enrollment hasn't gone as well in the few states that expanded Medicaid among the 36 states that let the federal government operate their exchange. There have been numerous technical problems, including a delay until Nov. 1 in the transfer of Medicaid applications from the federal site to state Medicaid agencies. According to reports, limited testing has been conducted on the transfers, raising fears that glitches could put some Medicaid enrollees at risk of not receiving coverage by Jan. 1.
Expanding Medicaid is a major way that the ACA seeks to reduce the number of uninsured Americans. The Congressional Budget Office projected that 9 million people would sign up for Medicaid by the end of 2014, compared with 7 million signing up for private coverage through the exchanges.
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.
Washington began running a marketing campaign in September to raise awareness, and deployed as many as 3,000 volunteers to help with Medicaid enrollment. Stevenson said the state expects enrollment to even out between Medicaid and private plans by the time open enrollment on the exchanges ends March 31. Unlike people signing up for private plans, those who qualify for Medicaid can enroll year-round in all states. “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 Medicaid is credited for signing up nearly 56,000 in the first two weeks after the state exchange opened. The state has not provided figures on how many people have enrolled in private plans through the exchange, which has experienced serious technical problems.
Since late September, Oregon has sent notices to as many as 260,000 residents who either are currently receiving benefits under the federal food stamp program or have children enrolled in Medicaid. The notices inform them that they pre-qualified for coverage beginning Jan. 1 and could consent to coverage by phone or by filling out a one-page form. “Our phones started ringing off the hook,” said Oregon Health Authority spokeswoman Patty Wentz.