Medicaid expands for adults

As of January 1st, the Affordable Care Act expanded Medicaid eligibility requirements to include adults living at or below 138% of the federal poverty level (about $15,000 per year for an individual). However, several state and local governments, including California, Minnesota, Connecticut, and Washington D.C., took advantage of the expansion provisions as early as 2010, prior to the mandated expansion this year.

These early participants can offer insight for what may be in store for other states. In the past, research has focused on newly eligible Medicaid participants who were disabled, parents with eligible children, or people with pre-existing health conditions. In their article published this year in Health Affairs, Sommers et al. collected data on the enrollment trends of childless, low-income adults now eligible for Medicaid under the ACA.

The study focused on the rate of change for Medicaid enrollees in Connecticut and D.C. before and after the eligibility expansion (between 2008-2009 and 2011) using the monthly Medicaid enrollment statistics and the Census Bureau’s American Community Survey (ACS). The authors examined data from each early participating state to estimate the rate of change in coverage compared to nearby states serving as controls. During the 2008-2009 period, D.C. and Virginia were noted to have comparable Medicaid and uninsured rates. In 2011, D.C. was noted to have a 3.7% (p=0.08) increase in Medicaid coverage for childless adults with incomes below 200% FPL when compared to Virginia. Connecticut was noted to have a 4.9% (p=0.01) increase in Medicaid coverage among childless adults with incomes below 56% FPL compared to its neighboring Northeastern states. Connecticut also saw a 2.7% (p<0.01) increase in Medicaid enrollment among low-income parents who were already eligible prior to expansion and a 2.8% (p<0.05) decrease in uninsured rates.

Commentary

The recent debacle regarding the technical glitches in debuting the healthcare.gov website in October 2013 once again called the successful implementation of the Affordable Care Act into question. The unflattering news coverage of the website and reinvigorated political opposition may have lead to skepticism and distrust among individuals who could potentially benefit from the expansion of state-funded Medicaid insurance coverage. However, the slow response to enrollment in state health exchanges should not be viewed as the public’s discontent with the law, as some opponents and media outlets would want us to believe. As noted in the article, as individuals become more familiar with the benefits of Medicaid coverage and the process of signing up becomes more streamlined, enrollment will increase over time. The goal should be that as enrollment increases, both political parties would work together to perfect the ACA and provide much needed resources and support to disadvantaged Americans.

Sommers, BD. et al. Health Affairs. 2014. 33(1): 78-87.