Early observations from several Medicaid expansion initiatives suggests states that expand eligibility this year will see a gradual increase in enrollment, with the first enrollees in comparatively poor health, according to a Health Affairs study.
Researchers from the Harvard School of Public Health in Boston and the Urban Institute's Health Policy Center in Washington, D.C., examined expansion initiatives that have taken place since 2010 in California, Connecticut, Minnesota and Washington D.C. Under the Patient Protection and Affordable Care Act, all states have the option of expanding their Medicaid programs to cover adults earning up to 138 percent of the federal poverty level. Starting this year, 26 states, including D.C., will have expanded Medicaid programs, according to the Kaiser Family Foundation. Indiana and Pennsylvania are looking into expansion after 2014.
Connecticut and D.C. extended Medicaid eligibility to some low-income childless adults that weren't previously eligible in 2010, and California and Minnesota did the same in 2011, according to the study. Based on an analysis of the progression of those expansion efforts, researchers found enrollment increased gradually as time went on. Connecticut and D.C. experienced steadily rising enrollment throughout the study period, and California showed a similar pattern. Minnesota's enrollment fluctuated significantly during the expansion's first months, but fairly small new enrollment numbers could have led to an exaggeration of normal economic or seasonal variations, according to the study.
These findings suggest the many other states expanding their Medicaid programs this year will see a similar pattern in enrollment, according to the study.
"This is going to take a while, for the expansion to have its full impact," says study co-author Benjamin Sommers, MD, PhD, an assistant professor of health policy and economics at the Harvard School of Public Health and an assistant professor of medicine at Harvard Medical School and Brigham and Women's Hospital in Boston. "It's not an overnight process to get millions of people into a new program."
He says healthcare providers can play an important role in motivating the newly eligible to sign up for coverage by educating people about Medicaid expansion.
Dr. Sommers and his co-authors also found people who enrolled in the first year after the expansion in one of the study states were mostly those in poor health. "This makes perfect sense if you think about who's going to benefit from health insurance and who's going to sign up," Dr. Sommers says.
That means the healthcare costs per new beneficiary will likely be high, at least initially. However, Dr. Sommers says despite the cost, an influx of people with serious health problems into Medicaid is a positive development.
"If we think about the law's ultimate goal to have a positive impact on public health, we really want those who have major medical issues to get cared for," he says.
Depending on the state's population, the study also found eligibility expansion will likely have positive spillover effects in terms of people signing up who were previously eligible but not enrolled.
Overall, the findings help predict who is likely to enroll in Medicaid as a result of expansion under the healthcare reform law, an understanding of which is crucial to the program expansion's success, according to the study.
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