One year after the implementation of the “key Medicaid provisions” of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148), the Kaiser Family Foundation (KFF) found that the expansion of Medicaid has contributed to a broadening basis of coverage for the low-income population and has “accelerat[ed] state efforts to move from antiquated, paper-driven enrollment processes to a new modernized enrollment experience.” In its 13th annual 50-state survey of Medicaid and Children’s Health Insurance Program (CHIP) eligibility, KFF highlights the data supporting these findings and emphasizes the status of coverage and enrollment experience for those in states that have chosen to expand Medicaid under the ACA and those in states that have rejected the expansion.
Expansion and Enrollment Numbers
As of the end of 2014, KFF reports, 28 states—including New Hampshire and Pennsylvania, both of which made the decision to expand Medicaid in 2014—had expanded Medicaid coverage to individuals with incomes of up to 138 percent of the federal poverty level (FPL). This led to an increase of median income eligibility levels in those states compared with the time before the implementation of the ACA, particularly among childless adults who were, for the most part, previously excluded from Medicaid coverage. On the other hand, in the 23 states that have chosen not to add a broadened base of Medicaid eligibility under the ACA, KFF states that levels of eligibility are very limited and “in all but one of these states (Wisconsin), childless adults remain ineligible for Medicaid regardless of their incomes.”
The KFF reports also notes, however, that Medicaid and CHIP coverage for pregnant women and children “remains strong,” as “all but two states cover children at or above 200 percent of the FPL through Medicaid and CHIP with 19 states covering children at or above 300 percent of the FPL.” Meanwhile 33 states provide coverage eligibility to pregnant women who have incomes at or above 200 percent of the FPL.
The report also revealed positive trends in regard to the streamlining and increased ease of enrollment as states are expanding Medicaid coverage under the guise of health care reform. Specifically, KFF found that, in all but one state, individuals are able to apply for Medicaid benefits at the state level online and “the majority of states are accepting Medicaid applications by phone.” In Tennessee, the only state where online enrollment applications are not available, individuals are instead directed to the federally-facilitated Marketplace (FFM) to enroll. Additionally, 36 states provide enrolled individuals an opportunity to set up an online account to aid in the management of their Medicaid coverage and 40 states have put processes into place that use electronic data sources to verify income prior to enrollment.
The KFF report also identified several new processes that have been created in states in an attempt to make further improvements in the enrollment process including the implementation of: (1) presumptive eligibility determinations for children and pregnant women; and (2) the Express Lane Eligibility (ELE) program, which uses other “means-tested programs such as the Supplemental Nutrition Assistance Program (SNAP)” to identify cases of eligibility for Medicaid and CHIP. Finally, the report found that 12 states operate a single, integrated system that makes eligibility determinations under the state’s Medicaid guidelines and Marketplace coverage options. The failure to implement this type of coordination in other states, KFF notes, contributed to delays in Medicaid eligibility determinations in 2014.
In more than one place in its discussion, KFF highlights the fact that there is no deadline for states to expand Medicaid under the ACA, as well as the fact that, in some states, the debate over Medicaid expansion will continue into 2015. On another note, the report’s authors caution that without Congressional action, CHIP funding is set to expire in September 2015. If this funding is withdrawn at that time, KFF warns that this will have budgetary implications on the state level.