Reducing enrollment frictions in Maryland

Maryland is making a big push to increase health insurance coverage in the state.  There is a recently signed bill that dramatically lowers the friction to enroll.  Stan Dorn, one of the architects of the policy proposal, has more at Health Affairs:

 the Maryland Easy Enrollment Health Insurance Program (MEEHP)….represents the country’s first attempt to use income tax filing as an immediate on-ramp to health coverage. By simply checking a box on their state income tax return asking the exchange to determine their eligibility for free or low-cost insurance, an uninsured tax filer can have relevant information from their return sent automatically to Maryland’s health insurance exchange. The exchange then uses that data and other available records to determine the individual’s eligibility for Medicaid, CHIP, and PTCs….

People who qualify for Medicaid or CHIP are invited to choose a managed care organization by a specified date. If they neither choose a plan nor opt out of coverage, they are enrolled in a Medicaid plan by default….

Uninsured tax filers with incomes too high for Medicaid or CHIP have a brief special enrollment period (SEP) for enrolling into the individual market. The SEP is triggered by the filing of a return with the relevant box checked, so long as the return is filed before a date specified by the exchange (presumably April 15 or earlier). The exchange determines PTC eligibility as quickly as possible, encouraging uninsured consumers to obtain insurance and helping them select an appropriate plan.

The default assumption in Maryland is that people want to be covered and the state government as well as the Exchange board should facilitate that coverage using current data streams.  Eyeballing 2019 data on RWJF Hix Compare, most single 27 year olds earning under 180% FPL will be exposed to at least one zero premium Bronze plan.  Older buyers and larger families will see zero premium plans at higher income levels.  Some families will see zero premium silver and gold plans.

Facilitating on-exchange enrollment is a net positive for the state as it will increase the number of people covered and most likely decrease the average morbidity in the pool.  It is the easier step as it costs the state a slight increase in administrative costs but no program costs.  The federal government takes on the entire incremental cost of increasing on-Exchange enrollment if that enrollment is exclusively coming through zero premium plans.

More notably is the commitment by Maryland to expand their Medicaid rolls.  Medicaid has split financing; some state and some federal.  Depending on the type of eligibility an individual has, Maryland is paying anywhere from ten to fifty percent of the incremental costs.  We saw with the launch of the ACA exchanges that there was a significant “woodworker” effect as people who were always qualified for Medicaid actually enrolled in Medicaid as health insurance coverage had higher salience.  We should expect a similar, but smaller, woodworker effect as Maryland uses its administrative systems to maximize enrollment.

Maryland is adding lubrication to the health coverage system while many other states are throwing sand to increase the friction people must fight through to get and maintain coverage.

7 replies
  1. 1
    gbbalto says:

    Thanks for this (and your other writing). Like a lot of others, I believe, I read all you write but have nothing to add. I’m glad to live in MD!

  2. 2
    Ohio Mom says:

    Isn’t Maryland the gerrymandered Blue State? Maybe there’s a relationship between that and this new bill…

  3. 3
    Cheap Jim says:

    Yeah, Maryland is gerrymandered in favor of the Democratic party. I know because I’m in the amorphous 3rd district now. As much as I like getting another D in Congress, I do miss voting for E. E. Cummings.

  4. 4
    Duane says:

    A state trying to help their citizens instead of hurting them. Trump’s adminisration may take them to court to stop it.

  5. 5
    David C says:

    It’s odd that this hasn’t been a big deal in my local FB feeds*, but it’s good news.

    * Maybe it was there but I missed it.

  6. 6
    Cermet says:

    Maryland also offers free colonoscopy screenings for anyone who cannot pay for the service even if they do not have any insurance at all.

  7. 7
    low-tech cyclist says:

    I often describe myself as a Virginia expat living in Maryland, because I’ve gotta admit my heart’s still in the Commonwealth. But things like this remind me that when I moved north of the Potomac due to a change of employment, I was also moving into a really good state.

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