State Medicaid and children’s health insurance programs have become significantly more efficient in their operations and more effective at enrolling those who qualify for coverage. As a result, more people are being covered, and the programs are operating more smoothly.
Those are among the findings of the 14th annual 50-state survey of Medicaid and CHIP (Children’s Health Insurance Program) operations by the Kaiser Commission on Medicaid and the Uninsured and Georgetown University.
Even with the increase in private insurance coverage resulting from the Affordable Care Act, Medicaid and CHIP still remain the primary sources of health insurance coverage for low-income children and pregnant women, the study found.
As of January 2016, 48 states cover children whose family incomes are at or above 200% of the Federal Poverty Level (FPL), with 19 states extending coverage to at least 300% of FPL. In addition, 33 states cover pregnant women with incomes at or above 200% of FPL.
Several states made incremental changes to their program in 2015 that expanded access to coverage, the study found. Michigan, Wisconsin and Colorado eliminated waiting periods for children to be enrolled in CHIP, while Nevada, Virginia and New Mexico made other changes that brought more children into their CHIP systems.
Medicaid’s role providing access to coverage for low-income adults continued to grow as a result of the ACA-funded expansion of state Medicaid programs.
As of the start of 2016, 30 states and the District of Columbia had expanded Medicaid eligibility to parents and other non-disabled adults with income up to at least 138% of the FPL. Three states – Alaska, Montana and Indiana – adopted Medicaid expansion during 2015.
In the 20 states that have not expanded Medicaid, many low-income adults have been left in a “coverage gap,” the study’s authors noted, because they earn too much to qualify for Medicaid but not enough to qualify for tax credit subsidies to purchase Marketplace coverage.
Regardless of whether states implemented the ACA Medicaid expansion, the health care law resulted in major changes in Medicaid systems and processes. Virtually all states have adopted new technology to make enrollment easier and faster for consumers, and more efficient for administrators of the state programs.
This is a significant change from 2014, when many states had problems implementing new systems, resulting in enrollment and renewal backlogs.
All 50 states can now accept Medicaid applications online, and 49 can accept them by phone. In 37 states, applicants are told within 24 hours whether they qualify for Medicaid coverage.
Among the 17 states that operate their own insurance Marketplaces, 13 have integrated Medicaid eligibility determinations into their systems, eliminating the need to transfer data and accounts.
That kind of integration has not yet happened with the federal Marketplace. The 38 states that rely on Healthcare.gov must transfer accounts electronically between that website and their Medicaid systems. Of these, 20 reported experiencing problems or delays resulting from these transfers.
The survey found little change in state practices regarding premiums and cost-sharing in Medicaid and CHIP. Premiums or enrollment fees are charged by 30 states, and 26 states require co-payments for children. However, these payments are substantially lower than would be required for employer-sponsored coverage.
At the start of the year, adults enrolled in Medicaid were charged monthly contributions or premiums in five states that have received federal waivers allowing them to impose these fees: Arkansas, Indiana, Iowa, Michigan and Montana. Indiana also charges parents a monthly fee for CHIP coverage, and cost-sharing for non-emergency use of hospital emergency departments.
The advances in Medicaid and CHIP may be affected by federal actions in coming years, the study noted. Funding for CHIP is set to expire in 2017, and other ACA support for children’s coverage ends in 2019.
In addition, state decisions about Medicaid expansion may be affected by the scheduled reduction in federal funding.
Under the ACA, the federal government will cover 100% of a state’s cost for Medicaid expansion costs for 2014, 2015 and 2016. Next year that reimbursement drops to 95%; it will then decline by 1 percentage point each year until it reaches 90% in 2022, after which it will remain at that level.
