Charles Gaba notes today that Pennsylvania’s Medicaid Expansion has seen more people sign up for it than were projected to be eligible for it. Michigan had the same pattern.
Well, one year after standard expansion went live, the state of Pennsylvania is reporting that:
As of April 2016, the expansion had reached 625,970 newly eligible Pennsylvanians, ages 18 to 64.
Yup, that’s 26,000 more people enrolled than anyone had even thought were eligible for the program.
I think a few things could be going on here. The first is that our system of counting the poor and near poor and the high income variance might not be as good as we thought it was.
Secondly, I think the woodworker situation should be examined. Woodworkers is a wonk term for people who were eligible for Legacy Medicaid but did not sign up for it. However there has been a three year consciousness raising outreach on the importance of getting health insurance as well as increased connectors to assistance combined with fewer administrative barriers to signing up for Medicaid (both Legacy and Expansion flavors of Medicaid). So a lot of people who were Legacy Medicaid eligible came out of the “woodwork” and signed up for Medicaid during one of the open enrollments.
My question on this is on the sub-population of Medicaid woodworkers who through a variety of circumstances could qualify for both Legacy Medicaid and income based Medicaid expansion. I know in states with a 1115 waiver such as Arkansas, these individuals are moved to the Legacy Medicaid pool but I am not sure how this works in states with a straight-up expansion.
Legacy Medicaid is split funded. The Federal government pays through the FMAP between 50% and 74.3% of Legacy Medicaid medical costs. The state picks up the remainder. Administrative costs are split a bit differently. Expansion Medicaid is currently single source funded. It is, until the end of this year, a 100% Federal program. Going forward it will eventually be a 90%-10% Federal/State split.
This is important from a state Medicaid administration point of view. An individual who is categorized as a Medicaid Expansion member is far cheaper (currently free) to the state government than someone who is on the books as a Legacy Medicaid member. From an individual beneficiary point of view, there is minimal difference besides different codes on their ID card, but this is a big deal at the administrative level. The states have every incentive to move as many people who could conceivably be qualified as Expansion eligible and Legacy eligible to Expansion.
My question for Pennsylvania, Michigan and other states with high Medicaid expansion enrollment is what percentage of those individuals are unique new individuals to Medicaid who would not have qualified under Legacy rules when they applied? If that number is low, then the shifting of membership to FMAP optimization categories would be low. If that number is high, then there is significant optimization happening.