Charles Gaba notes today that Pennsylvania’s Medicaid Expansion has seen more people sign up for it than were projected to be eligible for it. Michigan had the same pattern.
Officials expected that up to 600K would be eligible, and as of last summer 439,000 had already signed up. By December it was up to 500K.
Well, one year after standard expansion went live, the state of Pennsylvania is reporting that:
As of April 2016, the expansion had reached 625,970 newly eligible Pennsylvanians, ages 18 to 64.
Yup, that’s 26,000 more people enrolled than anyone had even thought were eligible for the program.
I think a few things could be going on here. The first is that our system of counting the poor and near poor and the high income variance might not be as good as we thought it was.
Secondly, I think the woodworker situation should be examined. Woodworkers is a wonk term for people who were eligible for Legacy Medicaid but did not sign up for it. However there has been a three year consciousness raising outreach on the importance of getting health insurance as well as increased connectors to assistance combined with fewer administrative barriers to signing up for Medicaid (both Legacy and Expansion flavors of Medicaid). So a lot of people who were Legacy Medicaid eligible came out of the “woodwork” and signed up for Medicaid during one of the open enrollments.
My question on this is on the sub-population of Medicaid woodworkers who through a variety of circumstances could qualify for both Legacy Medicaid and income based Medicaid expansion. I know in states with a 1115 waiver such as Arkansas, these individuals are moved to the Legacy Medicaid pool but I am not sure how this works in states with a straight-up expansion.
Legacy Medicaid is split funded. The Federal government pays through the FMAP between 50% and 74.3% of Legacy Medicaid medical costs. The state picks up the remainder. Administrative costs are split a bit differently. Expansion Medicaid is currently single source funded. It is, until the end of this year, a 100% Federal program. Going forward it will eventually be a 90%-10% Federal/State split.
This is important from a state Medicaid administration point of view. An individual who is categorized as a Medicaid Expansion member is far cheaper (currently free) to the state government than someone who is on the books as a Legacy Medicaid member. From an individual beneficiary point of view, there is minimal difference besides different codes on their ID card, but this is a big deal at the administrative level. The states have every incentive to move as many people who could conceivably be qualified as Expansion eligible and Legacy eligible to Expansion.
My question for Pennsylvania, Michigan and other states with high Medicaid expansion enrollment is what percentage of those individuals are unique new individuals to Medicaid who would not have qualified under Legacy rules when they applied? If that number is low, then the shifting of membership to FMAP optimization categories would be low. If that number is high, then there is significant optimization happening.
it’s an obvious indication of how Obamacare is failing and is the beginning of the death spiral and how the GOP plan would have prevented this from happening by only allowing those that should have insurance, to have insurance.
Villago Delenda Est
Just goes to show that this is complex, there are many variables, and the more variables, the more difficult it is to come to a concise, omniapplicable conclusion.
I’m glad for my fellow citizens that now have access to healthcare.
I’m wondering if eligible applicants feel there is somehow less stigma attached to applying for Medicaid now that it’s part of the ACA.
@piratedan: Exactly! An impoverished country such as ours can’t possibly afford to take care of everyone. Which doesn’t at all contradict the idea that we’re the richest, bestest country in the world, I’ll have you know!
I suspect, too, that now that the expansion is in effect people don’t have to be quite so concerned that they might get an extra shift at work & make $25 too much & get kicked off Medicaid. I know of a few people who didn’t bother because of the on/off cycle which can be really stressful plus you could end up owing the county money. The expansion leaves a bit more leeway.
It’s nice to be proud of my state. This is directly due to electing a Democratic governor last year. I don’t know how the wingnuts in the state will manage to either miss that connection or think the expansion is a bad thing, but I’m confident they’ll manage.
Meanwhile, other Corbett damage is only slowly being repaired because we only got a state budget about a month ago, 9 months late. I wonder what party has control of the legislature that caused that disaster? I feel for the people of Illinois, still going through this completely unnecessary death-by-government-body-that-doesn’t-govern.
@Gelfling545: Yeah, and not having the asset limit is a huge plus. Or a spend-down. People on the expansion don’t have to worry that their bank balance might edge up over $2000 before they pay their bills, or that saving anything for retirement will lose them their healthcare. And they don’t have to spend a massive amount up front on healthcare every month in order to get insurance. It’s got to cost a lot less to administer when you aren’t monitoring assets and spend-downs all the time.
Expansion Medicaid is less intrusive because it isn’t aimed at ensuring beneficiaries are and stay destitute. As a result, it’s more user-friendly and cheaper to run. Win-win.
I was under the impression that woodworkers would simply be assigned to the state’s legacy Medicaid population (with the relevant match rate). Or was I missing something in your piece?
@Fake Irishman: there is wiggle room in how a state can define category of assistance. An individual who on 12/31/13 is legacy Medicaid eligible but not enrolled could become Legacy and Expansion eligible on 1/1/14. Which bucket does a double qualified individual gets put in? From a state budget perspective the state wants every vaguely defensible case to go into Medicaid Expansion bucket.
As a resident of Illinois, I’d say that it’s the governor who’s not governing; the legislature is blocking him, and thank FSM someone is, because his whole agenda consists of (a) taking over the schools, especially in Chicago (presumably to sell it off to a Republican crony) and (b) destroying public unions. The most recent proposal is a graduated income tax (and our income tax rate is laughably low already), and he immediately fulminated about how it wouldn’t raise enough money and it Wasn’t Fair. Asshole.
W/r/t Medicaid expansion, I think it’s definitely a combo of the increased ability to stay on/eligible (as opposed to running the risk of being kicked off if you earn an extra nickel), and a massive effort to get people enrolled. At least in Illinois, there have been state funds (and we, as a community health center, have also received federal funds) to get people enrolled in insurance. A LOT of effort has been put into helping people understand their options, get enrolled in something they can afford, and then how to use the insurance (e.g., bring your insurance card with you when you come in for care). There are also signs all over the place–billboards, public transportation, etc.–encouraging people to get enrolled in insurance of some kind and providing phone numbers to do it; never saw that before Obamacare.