Medicaid leak-through

On Saturday, I noted that there was a Medicaid enrollment file issue.  Approximately 100,000 people on the Exchanges had thought they had enrolled in Medicaid  or CHIP but the federal files had not properly transferred to the states to process the enrollments.  At least half of the people impacted lived in either Ohio or Pennsylvania.

Ohio has expanded Medicaid but Pennsylvania has not.  So how is Pennsylvania impacted?

No state has ever had every person who was eligible for Medicaid (expanded or not) enrolled in Medicaid.   Some states aggressively outreach to everyone that they can enroll and have a very high percentage of eligible people enrolled in Medicaid.  Aggressive outreach can include enrolling people who are participating in other low-income programs such as SNAP or LIHEAP, community organizers conducting enrollment fairs and follow-ups after taxes are filed.  Other states don’t aggressively chase after people who eligible.  Instead, they count on people trickling in.

The launch of the Obamacare open enrollment period between October 1st and the end of March, 2014 is a massive shock to all enrollment systems and decision schemas.  People who were not covered have been going onto the Exchanges because there has been a massive push to get people who were not covered to get them covered.

Quite a few people have gone online and never thought that they were Medicaid eligible as that was for poor people and not them.  And once they entered their information, quite a few people, even in non-expansion states, were shocked to find out that they were Medicaid eligible.  The same scenario also played out for CHIP enrollment especially as CHIP has much more generous income restrictions than Medicaid.

This is how 25,000 or more people in Pennsylvania, a non-expansion state, are newly Medicaid eligible.

21 replies
  1. 1
    Debbie(aussie) says:

    Excuse my ignorance, but chip is for kids only, correct?

  2. 2
    aimai says:

    Wasn’t this the gist of that WSJ woman’s complaint–that her mother had had some kind of catastrophic policy which got cancelled, went onto the exchanges and discovered that she was “medicaid eligible” and “would not be permitted to purchase a plan on the exchanges” but instead had to take medicaid, which she found insulting?

    I really, really, really,wish the Democrats had simply forced through a name change and called Medicaid “Medicare” before starting the entire ACA program. If you type in “Medicaid” and the word “disgrace” accidentally, as I did in looking for the WSJ article, you find that an enormous portion of right wing america basically links Medicaid and poverty, illness, misery, disgrace, dirt, disorder, fraud, and black people. I mean–this isn’t a surprise but we could have short circuited a lot of the cultural purity/impurity hysteria by simply changing the name of Medicaid as a program, like the long ago Reagan stalwart and criminal who changed her last name in the middle of the congressional hearings about her crimes.

  3. 3
    Elizabelle says:


    Very good suggestion, aimai.

    Medicaid has a stigma, although one hopes that’s lessened in the wake of a jobless recovery and a tad more acknowledgement of our two-tier economic system. Medicaid is a lifeline too, although hardly anything one aspires to belong to.

    What to have called it? Medicare 2.0? Medicarenet? Medicarehealth?

  4. 4
    Richard Mayhew says:

    @Debbie(aussie): CHIP is for kids only, but administratively it is set-up to run a lot like Medicaid (feds pay most, states run the program), so CHIP and MA share quite a bit of the same federal back-end in general and even more on the Exchanges.

  5. 5
    MomSense says:


    My youngest is now on “Cub Care”. I pay a small premium (under $50) in addition to the premium I now pay for the rest of us. It is an SCHIP program run by the Office for Family Independence which is a part of DHHS. I would love it if we could change the name of Medicaid to Independence Care or something. The idea is that healthy people can work and go to school and move on up.

  6. 6
    Debbie(aussie) says:

    It seems to me that a benefit would accrue to the changing all these disparate programs to medicare for future simplicity. Our universal Program is Medicare.

  7. 7
    Gypsy Howell says:

    Or will this finally take the taint off of Medicaid, once more (white, real) Americans are on it? It might be harder for (white, real) Americans to vote for its dismantling and defunding if they’re actually benefitting from it.

    Oh who am I kidding, they’ll vote against it anyway.

  8. 8
    El Caganer says:

    I thought the problem with Medicaid is that fewer providers accept patients covered by it than they do Medicare. I don’t know if this is true, but I’ve read it on a number of different sites.

  9. 9
    Violet says:

    @Elizabelle: Freedom Care.

  10. 10
    polyorchnid octopunch says:

    This is a nit, but please… affected, not impacted. I guess I should be happy you didn’t say that the changes were impactful.

  11. 11
    Richard Mayhew says:

    @El Caganer: Medicaid provider networks do tend to be a bit smaller than Medicare networks. Medicaid normally pays significantly less than Medicare which pays less than private insurance for most physical health care, so not as many providers sign up for Medicaid.

    (The one big physical health exception is a 2 year trial of paying Medicaid primary care physicians Medicare rates — that has increased the number of docs taking patients)

  12. 12
    Richard Mayhew says:

    @aimai: They would still bitch as the realization that they’re not middle class in our wonderful classless society would create resentiment even if Medicaid got relabeled.

  13. 13
    WereBear says:

    The core discrepancy among the Wingnuts is that, yes, they are just as desperately poor and kept down as the African-Americans, but at least they are white!

    They will apparently suffer and die to keep that meaningless distinction.

  14. 14
    Elizabelle says:

    Independence Care is good.

    VirginiaCares. CarolinaCares. (Right, who am I kidding?)

    @Violet: great try, but that’s just going to get jerks screaming constantly that nothing in life is free.

  15. 15
    MomSense says:

    @Richard Mayhew:

    Do you know if there are any work-arounds for people who are Medicaid eligible except for their state’s refusal to expand Medicaid? Is it legal for these folks to overestimate their income so that they can qualify for insurance with subsidies?

    I’m just wondering if there are things we could do now to help the 5 million people who are otherwise screwed.

  16. 16
    LongHairedWeirdo says:

    @Debbie(aussie): It’s intended primarily for children, but can also be used (state’s option) for even childless adults.

    It’s a crazy thing; before health care reform, even some Republicans thought that providing health insurance was a good thing, and not islamofascisociamarxism.

  17. 17
    flukebucket says:

    @Richard Mayhew:

    They would still bitch as the realization that they’re not middle class in our wonderful classless society would create resentment even if Medicaid got relabeled.

    I don’t know about that. Being middle class in America now is starting to mean eligible for Medicaid.

  18. 18
    Aimai says:

    @Richard Mayhew: why does the government let anyone opt out? If a hospital wants that sweet medicare money why dont they have to take medicaid patients.

  19. 19
    Richard Mayhew says:

    @Aimai: Politics — forcing providers into Medicare or Medicaid would be socialism and price fixing and the greatest threat to our freedom since people objected to state sponsored prayer in public schools — the basic dynamic is that doctors are one of the most trusted groups in America and even Dr. Kevorkian has a higher public trust factor than Congress, so if/when a sizable number of doctors scream, they get what they want.

  20. 20
    aimai says:

    @Richard Mayhew: Oh, yes, I’m only pretending to be that naive. I know all about how the free market–i.e. the leveraging power that should come with having an enormous mass of potential customers, gets undercut by our medical providers and big pharma.

  21. 21
    Mnemosyne says:

    I realize that I’m perpetually 12 years old, but I keep seeing “leak-through” and snickering.

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