Almost a quarter of the population is covered by Medicaid. But not everyone who is on Medicaid knows it. Ashley Tallevi examines the implications of privatization features that leads to the misidentification of Medicaid as private insurance in the Journal of Health Politics, Policy and Law**:
When I measured privatization simply using managed care enrollment, which is the most widely used measure of Medicaid privatization in studies of Medicaid underreporting, I found no relationship between privatization and Medicaid self-reporting. However, when I specified administrative features of Medicaid managed care organizations (MCOs) that obscure government’s role, I found that these administrative features are related to the underreporting of Medicaid enrollment. Medicaid recipients become less likely to report their enrollment when MCOs mix Medicaid recipients and commercial enrollees in the same plan and when Medicaid MCOs include the private company’s name in the MCO plan name. I also found that, when this misreporting occurs, Medicaid enrollees are frequently reporting enrollment in private insurance plans.
Charles Gaba was curious about this question in 2015 and his data is stunning:
it’s jaw-dropping to discover that not only does Medicaid itself operate under more than 100 different names (some states have several separate or overlapping Medicaid programs), but that when you include CHIP and “other” state-funded healthcare programs the total number swells to over 200.
Going back to my main point: Of the 106 different Medicaid programs, only 15 of them (from just 12 states) have the word “Medicaid” in their actual publicly-branded name. For instance, in Connecticut, “Medicaid for Low-Income Adults” is referred to as “HUSKY Part D”. In Wisconsin, their main Medicaid program is called “BadgerCare”, but they do have another variant called “Wisconsin Medicaid Purchase Plan” or MAPP for short.
My last position at UPMC Health Plan was on the Medicaid team where I optimized risk adjustment revenue strategies for UPMC for You, the Medicaid managed care component of the company. This rings true to me. Every piece of advertising, branding and communication that I can remember focused on UPMC for You. Medicaid or Medical Assistance was seldom mentioned anywhere other than the Monday morning data geek team meeting.
One of the things that happily surprised me last year was the power of the Medicaid push back on the Republican health cut bills. Not everyone on Medicaid knew that they were on Medicaid although I would imagine that the parents of medically fragile children and the beneficiaries with significant, persistent high cost needs were very well aware of how Medicaid allows them to structure their life even if they were on Badger Care or Apple Care or UPMC for You or whatever else.
Medicaid is a critical resource for lots of families, but the naming conventions hides the value of that resource to some beneficiaries and the broader public.
** Ashley Tallevi; Out of Sight, Out of Mind? Measuring the Relationship between Privatization and Medicaid Self-Reporting. J Health Polit Policy Law 1 April 2018; 43 (2): 137–183. doi: https://doi.org/10.1215/03616878-4303489