Medicaid has a perpetual open enrollment period. Any one who is eligible can sign up at effectively any time. If likely to be eligible individuals are aware of this, we should expect new enrollments into Medicaid to be mostly evenly distributed throughout the year with perhaps bumps and clumps due to seasonal trends in regional economics and idiosyncratic attention shocks. However, my colleagues Paul Shafer of Boston University and Jesse Hinde of RTI looked at when people applied to enroll in California Medicaid throughout the course of the year in a new paper. They find that Medicaid applications spike during ACA open enrollment periods:
In some ways this is not surprising. There has been a long conversation about “wood workers’ — people who were always eligible for Medicaid but who were not enrolled coming out of the “wood work” when there was a huge attention shock in the form of advertising and general discussion about the ACA. In our other works, we show that ACA ads are extremely concentrated near and in the open enrollment period. But it implies that there are a large number of people who are eligible for care but where the information hurdle which changes height throughout the year effectively acts as a gatekeeper to needed medical insurance and likely medical care.
Well functioning public programs that are intended to actually serve the eligible populations should minimize informational and administrative barriers to access. This would mean the state would take on the responsibility of identifiying and enrolling people who are likely to be eligible based on data that the state routinely collects. This would mean regular advertising and destigmatizing messaging about programs. This would mean we likely change financing mechanisms. It means making enrollment in social programs and enrollment maintenance in these programs to be as easy as placing a hold mail order at the post office.
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WereBear
I was lucky in that NY has a free health navigator to walk one through the confusing software process. And I used to code and write tech manuals, so I can say a lot of it is inevitable when it’s so complex.
There’s so many boxes to land in. When I lost my job insurance, I was broke enough to qualify for cheap, then free, care while keeping my own doctor. Who is a mensch and will take Medicaid.
What a difference a blue state makes, though. My original life plan was an academic career in Florida. Where I would not have fared so well, then or now.
Raven
Ha! These morons in Georgia will be all over that!
Scamp Dog
Connect for Health Colorado does a check for Medicaid eligibility during its signup process, so I’m sure that plays a role. States that don’t want their citizens covered won’t do that, I imagine.
Fake Irishman
Obviously the next research question here is how much these enrollment bumps vary across states with different Medicaid policy regimes. The ACA streamlined much of the application process across all states, but the Mississippis of the world still find ways to make applicants swim across moats filled with Alligators on the Fifth Tuesday of the month between 4 and 4:07 a.m to enroll.
MarkPainter
When I was a state legislator in Pennsylvania, the Republicans were strictly opposed to the Medicaid expansion, and one of their reasons for turning down a free program was the “woodwork effect;” that is, that publicity around a Medicaid expansion would also draw people eligible for regular Medicaid “out of the woodwork” and this would cost the state money.
Aside from the appalling idea that we should try to save money by not telling people about programs they are eligible for, I really resent the “woodwork” analogy. What kind of thing literally comes “out of the woodwork?” Mice, cockroaches, vermin. The fact that some cheerfully analogize poor people to vermin is a real tell.
David Anderson
@Fake Irishman: what time zone though?
David Anderson
@Scamp Dog: All ACA marketplaces, either state based, like Colorado, or the federal marketplace Healthcare.gov are required to do a Medicaid eligibility check first. The ACA subsidies are fundamentally intended to be subsidies of a last resort. Individuals only qualify for ACA subsidies if they don’t have a reasonable offer of affordable insurance from another source including Medicaid. Now what happens after the eligibility check and determination that Person X is very likely Medicaid eligible is a damn good question… @FAkeIrishman has a nose for those questions.
Fake Irishman
@David Anderson:
the Fifth Circuit has held the state has no obligation to inform potential beneficiaries of that.
Fake Irishman
@David Anderson:
Thanks! Now if only I had a nose to find the answers to those questions…. (Probably involves talking to people at the Kaiser Foundation who are smarter than me)