Officials from state insurance exchanges say they've uncovered an unforeseen trend as the result of Medicaid expansion: Some of the newly eligible would rather buy private insurance through the exchange than join the public program.
Representatives from the California, D.C., Kentucky and Rhode Island exchanges discussed the phenomena during a media briefing hosted by the Robert Wood Johnson Foundation on Jan. 31.
The primary reason appears to be the stigma of Medicaid as the public dole. In Kentucky, for instance, the pushback has largely come from young college graduates, who may have come from middle-class families, but are unemployed and possibly unable to get on their family's plan, according to Audrey Haynes, secretary of Kentucky Cabinet for Health and Family Services.
The number of people who fall into this group is small, but it's an issue that should be addressed, the officials said.
“This is another piece of the law that needs to be fixed because people should be allowed to this,” said Christine Ferguson, director of the Rhode Island Health Benefits Exchange.
As the law is written, a person found eligible for Medicaid does not qualify for tax credits to buy insurance on the exchange.
Washington has seen fewer than 50 cases in which applicants have asked to enroll in exchange plans after they were deemed eligible for Medicaid, according to Mila Kofman, executive director of the District's Health Benefit Exchange Authority. In those instances, the state manually deleted the original applications and gave the residents forms to get insurance at full price.
“That is not something I expected to see,” Kofman said. “When folks qualified for our comprehensive public program, I expected them to enroll.”
A related concern is that applicants tentatively deemed eligible for Medicaid by mistake must wait weeks before they get a formal denial letter before they can re-apply for private insurance.
Follow Virgil Dickson on Twitter: @MHvdickson