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Medicaid, CHIP enrollment higher with streamlined marketplace
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Larger increases in public coverage through Medicaid and the Children’s Health Insurance Program, or CHIP, occurred between 2013 and 2015, when options were available to enroll within the marketplace, regardless of whether that marketplace was state or federally facilitated, according to a research letter published in JAMA Pediatrics.
Julie L. Hudson, PhD, and Asako S. Moriya, PhD, from the Center for Financing, Access and Cost Trends at the Agency for Healthcare Research and Quality, wrote that under the Affordable Care Act’s “no wrong door policy,” all marketplaces are required to examine whether those applying for coverage are eligible under Medicaid/CHIP; however, only state-based marketplaces are required to enroll applicants who are eligible for these programs.
“States relying on federally facilitated marketplaces, including those with state-federal partnership or federal information technology support, can opt to defer final enrollment authority to state-level Medicaid/CHIP agencies,” Hudson and Morita wrote. “Take-up of public coverage in these states could be dampened if Medicaid/CHIP-eligible applicants face process delays, process errors or reversals in applicants’ assessed eligibility.”
Children aged between 0 and 18 years with no reported disabilities and their parents who lived within a state that took on the ACA Medicaid expansion were included in this study. Hudson and Moriya assessed the changes in coverage for several marketplace policies for four different groups: Medicaid/CHIP-eligible children at 400% of the federal poverty level, parents below 400% of the federal poverty level who were previously eligible for Medicaid before the ACA, parents who became eligible for Medicaid coverage through the ACA and parents between 0% and 138% of the federal poverty level who were Medicaid-eligible through the ACA expansion to adults.
Public coverage increased in all four cohorts, according to the researchers. Parents who were newly eligible for coverage through Medicaid demonstrated the highest gains; however, coverage increased among parents and children who were eligible for coverage before the ACA. The researchers observed increases of 22.8 percentage points for newly eligible parents, 8.8 percentage points for parents eligible for coverage before the ACA and 4.8 percentage points for children who were previously eligible in states who ran state-based marketplaces.
When states had no authority to enroll eligible applicants for Medicaid/CHIP, their increases in public coverage were smallest. This was observed through a 14.7-percentage-point increase in states that were not allowed to enroll applicants, compared with the 22.8-percentage-point increase observed when states had this authority. Rates of coverage were highest with federally facilitated marketplaces that could enroll applicants, where Hudson and Moriya observed a 23.9-percentage-point increase.
The researchers noted that no substantial differences were observed in state-based and federally facilitated marketplaces when both had enrollment authority.
“Our results suggest that streamlining Medicaid/CHIP enrollment may have played a substantial role in increased take-up of public coverage,” the researchers wrote. “Increases were larger in states where Medicaid/CHIP enrollment occurred within the marketplace, regardless of whether the marketplace was state-based or federally facilitated. The findings of this study highlight program coordination as a potential tool for child health policy by reaching the eligible uninsured and increasing joint parent-child Medicaid coverage.” – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.
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