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.