Sunday, January 12, 2014

ACA Statistics and the Reported Medicaid “Eligible”

“Federal health officials announced on Wednesday that some 1.2 million people selected plans on federal or state exchanges during the months of October and November. That included 803,000 people who applied to the exchanges and were found eligible for Medicaid or a related Children’s Health Insurance Program that provide public insurance for the poor — in addition to nearly 365,000 people who chose private plans.” - Medicaid Outpaces Private Plans, NYT Editorial Board, 12/16/2013 (1)


The above is merely an example of a reference to the amount of people applying for Obamacare yet are found to be Medicaid eligible. Further, the above excerpt is somewhat correct in that: “…were found eligible for Medicaid or a related Children’s Health Insurance Program…”. That is, they were not enrolled in Medicaid, they where merely found eligible. Then again, many found “eligible” are not. Moreover, the term “eligible” is a bit misleading as the term “identified” is the correct term. (2)

Many news stories seem to implicitly assume ACA web sites determine eligibility for enrollment into Medicaid and/or the reader comes away with the impression that Medicaid enrollment is spiking. That is likely not the case. How so?

If one goes onto the Obamacare exchange aka “market place” one might very well be identified as eligible for Medicaid. The key is “identified”. The marketplace/exchange has no ability or authority to enroll those identified into any Medicaid plan. The process is to “identify” individuals that appear to be eligible then send contact information to the state of residence of such individual, specifically to the state Medicaid Department, of those identified, to determine eligibility for Medicaid.

If one lives in the states that did not expand Medicaid, via the Supreme Court ruling in their favor, then a narrative appears on the exchange web site stating your state did not expand Medicaid. Hence the number of Medicaid identified ("eligible") one sees in a news reports should be in the states that expanded Medicaid under Obamacare. (3) (4) (5)

Next one needs to consider “identified” vs. “eligible” are worlds apart. One would need to go through the eligibility paperwork [bureaucratic forms of confusing nature] and the application reconciled, reviewed, etc. by the bureaucracy. Stated alternatively, the “identified” becoming “eligible” is a long arduous process.

One must also consider the logistics of haggard state Medicaid Departments having the time to make outgoing contact with the “identified”. Such departments already have case loads and the time available to follow up is surely at a premium. Even then, is the contact follow up information correct?

Next comes the historical percentage of Medicaid eligible that actually follow through and apply for Medicaid. The national historical average of those eligible for Medicaid that actually apply for Medicaid is 61.9%. (6)

One should consider that any number of “eligible” Medicaid recipients in a news story is really the “identified” and the number reported should be discounted heavily given the “identified” vs. “eligible," the “identified” being determined eligible and the process thereof and finally the historical percentage that actually apply vs. eligible.



(1) Medicaid Outpaces Private Plans, NYT Editorial Board, 12/16/2013.

(2) Brokers are reporting that some of their clients are in insurance limbo as they wait for the error to be corrected by HHS or their states, USA Today, 12/09/2013

(3) After Supreme Court ruling, Medicaid expansion faces uncertainty, Christian Science Monitor, 01/29/2013


(4) Why States Have a Huge Fiscal Incentive to Opt Out of Obamacare's Medicaid Expansion, Forbes, 07/13/2012

(5) Why States Are So Miffed about Medicaid — Economics, Politics, and the “Woodwork Effect”, Benjamin D. Sommers, M.D., Ph.D., and Arnold M. Epstein, M.D., N Engl J Med 2011; 365:100-102 July 14, 2011 DOI: 10.1056/NEJMp1104948

(6) Why States Have a Huge Fiscal Incentive to Opt Out of Obamacare's Medicaid Expansion, Forbes, 07/13/2012

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