Participants included Latinos, young adults 18 to 34, parents of young children, and childless adults who have either applied to the program or are eligible but have yet to seek coverage under the program.
“There's been a significant communications failure,” Andrea Cohen, a MACPAC commissioner and director of health services in the New York City mayor's office, said at the meeting.
That failure could be a casualty of the states' efforts to publicize the private coverage and the subsidies available through the insurance marketplaces, said study co-author Michael Perry, partner at Perry Undem Research/Communication. “My sense is that explicit messaging about Medicaid has not been a part of many states outreach,” Perry said.
States may be relying on organizations working under state and federal grants as “navigators” to get the word out about Medicaid via grassroots outreach, “but nothing on the airways,” he said.
There is evidence of weak numbers of newly eligible enrollees in other states that have expanded their programs. In response to requests for data from Modern Healthcare, Washington state officials said that about 65% of the 380,911 people who signed up for the state's Medicaid program between Oct. 1 and Jan. 9 were in the program in 2013. In West Virginia, another expansion state, only about 75,000 of the more than 420,000 people who enrolled between Oct. 1 and Jan. 15, were new to the Medicaid program.
In addition to lack of awareness, stigma associated with being on the program could be playing a part in why newly eligible enrollees are for now steering clear, said Aaron Katz, a health policy lecturer at the University of Washington's School of Public Health.
“As (the newly eligible) have higher incomes than those who've been on Medicaid previously … it may just take them some time to accept they need the help and figure how to get it,” Katz said.
Another factor could be the ongoing technology problems with the state and federal exchanges, according to Dan Hawkins, senior vice president of public policy and research at the National Association of Community Health Centers.
The CMS still has limited ability to transmit completed Medicaid applications from HealthCare.gov to state Medicaid agencies. State exchanges are also experiencing trouble in sending applications to the agencies in their regions. As a result, people have been asked to apply multiple times before they're actually enrolled.
“I'm afraid some people just give up,” Hawkins said.
Some states that have chosen not to expand their programs, however, are seeing a flood of new interest in Medicaid coverage.
In Florida, for instance, state officials told Modern Healthcare that of the 303,374 new enrollees added to Florida's program, more than half had not been enrolled during the last 12 months.
“The state has done little or nothing to aid these individuals to get enrolled, but they are finding a way,” Hawkins said.
The numbers suggest a so-called “woodwork” effect—people who were already eligible but not enrolled in Medicaid are signing up as a result of the publicity around the healthcare reform law.
The report commissioned by MACPAC also indicated that state Medicaid agencies are struggling to follow-up with new enrollees to help them get access to care.
Medicaid directors from Maryland and Tennessee told the panel that staffs are stretched thin because the responsibilities of their offices have grown in recent years to include oversight of the exchanges, new health information technology programs, managed-care programs and waiver demonstrations.