News Feature | March 11, 2014

GOP Questions Medicaid Enrollment Estimates

By Christine Kern

GOP Medicaid Enrollment

Republicans say new analysis of Medicaid Enrollment may not be telling the whole truth

New research from Avalere Health estimates that between 2.4 million and 3.5 million Americans were newly enrolled in Medicaid from October through January as a result of the Affordable Care Act.

According to Modern Healthcare, the Obama administration has said that 8.9 million individuals are eligible for Medicare or the Children’s Health Insurance Program (CHIP) through state Medicaid agencies and state-run insurance exchanges, and an additional 1.2 million are Medicaid-eligible through HealthCare.gov.

According to Avalere’s website, these enrollment estimates were developed by comparing reported data on new enrollments from October through January to enrollment rates from the summer of 2013. The estimates include both individuals who are newly eligible for Medicaid as a result of states’ expanding eligibility under the ACA and those who were previously eligible but newly enrolled due to greater awareness of coverage options (also known as the “woodwork” population). Avalere’s estimates remove individuals who would have been enrolled in Medicaid absent the ACA, including eligibility renewals in some states.

Avalere's estimate includes Medicaid enrollment both through the federally run and state-run exchanges. Avalere compared the number of new Medicaid and CHIP applications from October through January to the average monthly number of applications submitted from July through September of 2013 as a control.

Avalere’s study indicated that as of Jan. 31, between 1.7 million and 2.7 million people were newly enrolled in the states that have expanded Medicaid to adults with incomes up to 138 percent of the federal poverty level, while 700,000 to 800,000 people were newly enrolled in the non-expansion states.

These numbers are being challenged by officials in the mostly Republican-led states relying on the federal HealthCare.gov insurance exchange to determine Medicaid eligibility, who argue the actual number of people who have successfully enrolled in their states may only be in the tens of thousands. Obamacare and the expansion of Medicare generally have been opposed by elected Republican officials in those states.

Modern Healthcare reports that Texas, for example, which has the highest percentage of uninsured in the country, has processed 6,703 Medicaid files for individuals received from the federal exchange, according to state Medicaid officials. However, of those, only 904 have been approved and enrolled for coverage. The rest were either already on Medicaid, not eligible, or didn't complete their applications. CMS says it has found 392,675 Texans to be eligible for Medicaid since the federal insurance exchange opened.

Officials in several Republican-led states relying on HealthCare.gov said they doubted enrollment figures in the non-expansion states were remotely close to the 1 million mark, including both new enrollees and people re-enrolling into the program through Healthcare.gov. State officials from Alaska, Arizona, Georgia, Michigan, Mississippi, and Wyoming told Modern Healthcare the number of Medicaid applications from HealthCare.gov actually processed was very low, either because they aren't receiving them yet or because they are in a testing phase during which the CMS is sending them Medicaid applications to check on the connection between the federal and state databases. They say the CMS has told them not to make eligibility determinations until the testing process is completed.

Idaho, Oklahoma, Kansas, and Maine have all received far fewer completed applications than the number of those estimated to be eligible. Tom Shanahan, a spokesman for the Idaho Department of Health and Welfare, reported, “Idaho is not yet getting the enrollment numbers in Medicaid that were expected. We projected about 35,000 individuals to be eligible but not covered. As of today, the only new enrollments that can be counted are the 1,900 that have come from HealthCare.gov.”

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