Tuesday, December 3, 2013

Eligible for Medicaid, but Didn't Know It?

You may have noticed that there have been a lot of news items since the passage of the ACA, and even more since we are getting closer to the beginning of the year (and I'm not referencing the political differences about the ACA).  One of the positive side-effects of the ramp up of the ACA to January 1, 2014 is that some who didn't know they were eligible for Medicaid now do.

Chris Kardish, for Governing, wrote an article Even in States That Aren't Expanding, Thousands More Qualify for Medicaid. Although this was somewhat anticipated, the article notes that 

Reports delivered to state legislatures referred to this population as the “woodwork effect”—people who were eligible under the existing program but didn't know it until they sought insurance from an online marketplace known as an exchange. With the recent release of first-month enrollment data from state and federal exchanges, they’re getting a glimpse of the effect, but experts caution that it’s too early to make any conclusions about its budgetary impact this fiscal year

The article reports that among the exchanges (state, federal and DC), 400,000 were either Medicaid- or  CHIP-eligible.  However, the number on its face can be misinterpreted, as the article goes on to explain.  This number (from HHS) makes no differentiation "between people who were already eligible and those who are part of the expansion population, but about 100,000 of them came from non-expansion states, indicating that upward of a quarter or more of potential new sign-ups were already eligible." 

Although estimates as to how many beneficiaries will be added to Medicaid is more susceptible to calculation, the "woodwork" numbers  are more problematic.  The article goes on to discuss that some states have indicated the numbers to be greater than expected and others, less. 

The "woodwork effect" numbers cannot be ignored, however. As the executive director of the National Association of State Budget Officers explained in the article "the health of people coming to Medicaid offices through the woodwork effect matters a lot more than their overall numbers. With a program like Medicaid, which is prone to unpredictability and cost overruns, state officials already expect the unexpected and have done so in anticipation of the health law..."

For some individuals living in states not expanding Medicaid and ho didn't know about their eligibility, this  can be pretty darn good news. Cloud....silver lining, anyone?





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