Variation in Medicaid Eligibility and Participation among Adults: Implications for the Affordable Care Act

Abstract

Steep declines in the uninsured population under the Affordable Care Act (ACA) will depend on high enrollment among newly Medicaid-eligible adults. We use the 2009 American Community Survey to model pre-ACA eligibility for comprehensive Medicaid coverage among nonelderly adults. We identify 4.5 million eligible but uninsured adults. We find a Medicaid participation rate of 67% for adults; the rate is 17 percentage points lower than the national Medicaid participation rate for children, and it varies substantially across socioeconomic and demographic subgroups and across states. Achieving substantial increases in coverage under the ACA will require sharp increases in Medicaid participation among adults in some states.

The Effect of the 2014 Medicaid Expansion on Insurance Coverage for Newly Eligible Childless Adults

“…This pattern is consistent with pre-ACA research on Medicaid take-up, and it mirrors a recent study showing that early enrollees in Marketplace policies were older and more likely to use medication than later enrollees (Donohue et al, 2015;Kenney et al, 2012).…”

A potential new data source for assessing the impacts of health reform: Evaluating the Gallup-Healthways Well-Being Index

“…2 Survey data in general is used extensively in health services research, particularly for studies of large coverage changes and insurance participation rates. [3][4][5][6] With major insurance expansions under the ACA set to begin in 2014 7 and ongoing major changes in health care delivery, the availability of rapid and accurate estimates on coverage and access to care will be critical. While administrative data can often provide rapid and accurate estimates of how many individuals have enrolled in or utilized a particular program, survey data provides an important cross-sectional view of overall coverage rates in the population, across the range of government programs and private plans.…”

Medicaid at 50 — From Welfare Program to Nation’s Largest Health Insurer

“…In addition to expanding eligibility dramatically, the ACA also aimed to streamline the Medicaid application process and eliminate financial asset tests for many applicants in order to improve the participation rate among eligible adults -which was roughly 60% before passage of the ACA, owing to cumbersome enrollment and renewal procedures, variable program quality, stigma, and lack of awareness. [17][18][19] Given the dramatic increase in the number of Medicaid enrollees and the contentious divide that separates the political parties over the ACA, there has been growing interest in evaluating the program's successes and failures and how it is perceived by the public. Cross-sectional studies have noted that Medicaid beneficiaries have worse health outcomes than those with private insurance and, in some cases, than persons without any insurance.…”