Biggest reason for initial jump in
Medicaid enrollment is that hundreds of thousands in expansion states
have been pre-qualified for expanded Medicaid -
see state-by-state report
By Christine Vestal, Stateline
Nov. 7, 2013 - States are reporting
far higher enrollment in Medicaid than in private insurance since the
Affordable Care Act exchanges opened Oct. 1. In Maryland, for example,
the number of newly eligible Medicaid enrollees is more than 25 times
the number of people signed up for private coverage.
Even some Medicaid experts say they
are surprised at the early numbers.
A Stateline survey of the 25
expansion states and the District of Columbia provides clear
explanations for the strong Medicaid rollout so far.
The biggest reason for the initial
jump in Medicaid enrollment is that hundreds of thousands of people in
the expansion states have been pre-qualified for expanded Medicaid
because they are already enrolled in low-income state health care.
Illinois, for example, will roll over 100,000 Cook County residents who
have received expanded Medicaid benefits since 2011.
Another reason for the big numbers
is aggressive outreach campaigns in many states, including mailings to
residents enrolled in other safety net programs. Oregon, for example,
signed up 70,000 enrollees in October by contacting residents who
A much smaller number of people in
expansion states are also signing up on state exchanges and Medicaid
websites. The federal government has not yet released the number of
Medicaid applications filed on federally-operated exchange sites in the
32 states that are not running their own exchanges.
To be sure, the rush to enroll in
Medicaid indicates a strong demand for health care coverage. But the
early spike is more a function of states’ proven ability to find,
educate and enroll low-income residents than an indication of an
imbalance with healthier people who can afford insurance, as has been
It is important to note that early
enrollment numbers reflect so-called “low hanging fruit,” said Matt Salo,
director of the National Association of Medicaid Directors. Future
increases are expected to be smaller.
The states that chose to expand
Medicaid, Salo said, are predisposed to aggressively reach out to
potential beneficiaries. “Most have been more committed to Medicaid than
the other states,” he said.
After the U.S. Supreme Court ruled
last year that Medicaid expansion was up to states, the Congressional
Budget Office downgraded its original
projection that 13 million people would qualify for expanded
Medicaid in 2014 and 17 million by 2020. Now, the federal estimate is
7 million by the end of 2014 and 11 million by 2020.
survey indicates at least 1.5 million people have already signed up or
have been pre-qualified for expanded Medicaid in the 19 states that
provided counts. Expected total enrollment in those states is 3.7
Following are the details available
as of Nov. 5:
number of new applications is not available at this time. In total,
Arizona expects 57,000 people to qualify for its expanded Medicaid
program. In addition, the state expects 240,000 more individuals to
enroll in its existing Medicaid program for childless adults with
incomes at or below the federal poverty level ($11,490). Enrollment in
that program was frozen in 2012 and currently totals 70,000.
has received 70,595 applications for its expanded Medicaid program. Of
those, 3,672 came through the state’s existing Medicaid website, 1,785
were paper or phone applications, and the rest were positive responses
to a mailing to 132,000 households that receive food stamps. Ultimately,
the state expects about 250,000 uninsured residents to qualify.
plans to release enrollment numbers from its state-run website in
mid-November. Newly eligible enrollment in expanded Medicaid is expected
to total about 1.4 million. Of that number, 600,000 people will come
from the state’s early expansion program approved by the federal
government in 2011.
has qualified more than 25,000 adults for its expanded Medicaid program.
Of that number, approximately 9,000 were on a waiting list for an
existing Medicaid program that covers adults with extremely low
incomes. Another 10,000 people enrolled in that program will also be
transferred to expanded Medicaid coverage in January. Combined, that
comes to 35,000 individuals, more than 20 percent of the 160,000
uninsured residents Colorado expects to be eligible for its expanded
has enrolled 3,550 new people in its expanded Medicaid program through
its state-run exchange and Medicaid website. In addition, at least
48,000 enrolled in a state-run low income-health program have already
been moved into expanded Medicaid. Connecticut expects a total of 55,000
expanded Medicaid enrollees in 2014.
new enrollment data is available yet. Delaware already provides Medicaid
coverage for 30,000 adults with incomes up to the federal poverty level
($11,490). Its expanded Medicaid program is expected to cover another
30,000 people with incomes between $11,490 and 138 percent of the
federal poverty level ($15,856).
District of Columbia: D.C.
began expanding its Medicaid program in June 2010. By June 2013, nearly
50,000 new people were enrolled. The District has not estimated how many
people will ultimately enroll in expanded Medicaid.
has approved 6,100 applications for expanded Medicaid. By 2014, the
state expects a total of 54,000 enrollees.
Illinois Medicaid agency has received 30,124 applications for expanded
Medicaid through its existing website. Illinois has an exchange
partnership with the federal government so applications are also being
filed on the federally-run exchange. In addition to online applications,
46,000 people responded to an August mailing to 123,000 food stamp
recipients. Illinois has enrolled 26,000 of those respondents and is
processing the balance. In addition, 100,000 people in Cook County who
participate in a limited early Medicaid expansion enrollment group will
automatically be rolled over to the expansion program on Jan. 1.
Projected enrollment is 342,000.
new numbers are available on Medicaid applications. In all, 150,000
uninsured Iowans are expected to qualify under the proposed expansion.
About 63,000 residents with incomes up to 200 percent of the federal
poverty level ($22,980) are currently enrolled in a Medicaid health plan
with limited benefits. Most are expected to qualify for expanded
Medicaid. Iowa has not yet received federal approval for its Medicaid
expansion plan, which is similar to Arkansas’ so-called private option.
has received 25,654 applications for expanded Medicaid through its
state-run exchange. Ultimately, the state expects 308,000 low-income
individuals to qualify.
number of applications from its state-run website is not yet available.
However, Maryland has an existing, limited-benefit health plan known as
Primary Adult Care (PAC) available to all adults with incomes up to 123
percent of the federal poverty level ($14,133). As of Sept. 30,
enrollment in the plan was 82,423. Maryland expects enrollment in PAC to
expand to 88,000 by Jan. 1, 2014, when the entire population will
automatically convert to full Medicaid benefits. In addition, residents
in a narrow income band (124 percent to 138 percent of poverty) can sign
up for expanded Medicaid on the state exchange. Overall, Maryland
expects 110,000 people to be enrolled by the end of 2014.
enrollment numbers are available at this time. As a result of its own
health care reforms launched in 2006, Massachusetts has a 97 percent
insured rate. Still, the state expects about 45,000 people to obtain
Medicaid coverage as a result of the expansion.
enrollment numbers are available. The Michigan legislature approved
Republican Gov. Rick Snyder’s proposed Medicaid expansion in September
but postponed implementation until April 2014.
federal government granted Minnesota special permission to enroll 84,000
individuals in the expanded Medicaid program in 2011. Another 2,496
newly eligible Medicaid beneficiaries completed applications on the
state-run exchange in the first two weeks of October. Ultimately,
Minnesota expects to cover 265,000 adults in its expansion. In addition,
it is the only state that has opted to provide a so-called “Basic Health
Plan” for people with incomes up to 200 percent of the federal poverty
line ($22,980). Under the ACA, the federal government will pay 85
percent of the costs starting in 2015. That program is expected to grow
information is available at this time.
New Jersey: No
information is available at this time.
New Mexico: New
Mexico has approved 2,507 applications for expanded Medicaid through the
federally operated exchange and its existing Medicaid website. In
addition, 100,000 enrollees in two limited-benefit state health care
programs will be rolled into the expanded Medicaid. New Mexico expects
130,000 people will be in the expanded program by 2015.
New York: No
enrollment numbers are available yet. New York already covers parents
with incomes up to 150 percent of the federal poverty line ($17,235) and
childless adults with incomes up to the poverty line ($11,490).
North Dakota: The
Medicaid agency has received 147 applications for expanded Medicaid. In
December, the state plans to send letters to 36,000 households that
receive food stamps or home heating assistance, inviting eligible adults
to sign up for expanded Medicaid. Total enrollment in expanded Medicaid
is expected to reach 32,000.
most recent state to expand Medicaid, Ohio expects to sign up 275,000
newly eligible Medicaid enrollees. Republican Gov. John Kasich
sidestepped the state legislature and won approval for expansion Oct. 21
from an executive branch Controlling Board. The state has not yet begun
enrollment. The Medicaid agency says it will announce soon when
enrollment will begin.
has approved 70,000 applications for expanded Medicaid. Its state-run
website had some initial technical difficulties, but new applications
were filed over the phone, in person and through the mail. The vast
majority of enrollments came from a mailing in late September that went
to 260,000 residents who either receive food stamps or have children
enrolled in Medicaid. The state expects roughly 223,000 adults to be
enrolled in its expanded Medicaid program by 2015.
Rhode Island: Rhode
Island has approved 3,213 new applications for its expanded Medicaid
program. Another 835 are in progress. Projected enrollment is 23,428.
1,000 individuals have signed up for Medicaid on Vermont’s exchange or
by submitting paper applications. In addition, 30,000 adults enrolled in
two state-run low-income health plans will be rolled into the expanded
Medicaid program. By 2015, Vermont expects enrollment to reach 160,000.
its state-run exchange and Medicaid sites, Washington has signed up
26,336 people. Another 30,000 people enrolled in a low-income health
program will be automatically enrolled in expanded Medicaid, bringing
the total to 56,336. The state expects 270,000 people to qualify by the
end of 2014.
West Virginia: West
Virginia has pre-qualified 52,056 residents for its expanded Medicaid
program. Projected new enrollment is 63,000.
This story comes from our Kaiser
Health News partner
Stateline, the daily news service
of the Pew Charitable Trusts.
Stateline reporters Michael
Ollove and Elaine S. Povich also contributed to this report.