Dive Brief:
- More than 2.3 million people in the U.S. would gain access to health insurance next year if 10 holdout states expanded Medicaid eligibility, according to an analysis by the Robert Wood Johnson Foundation and the Urban Institute.
- Groups who would see the largest coverage gains due to Medicaid expansion include non-Hispanic Black people, young adults and women, especially those of reproductive age.
- The report comes as states have begun disenrolling beneficiaries from Medicaid after a period of continuous enrollment during the COVID-19 public emergency.
Dive Insight:
Under the Affordable Care Act, states have the option to broaden Medicaid eligibility to individuals with incomes up to 138% of the poverty level, significantly adding access to the safety-net insurance. Ten states still have not expanded coverage, with North Carolina and South Dakota only recently bolstering their programs.
For many adults in non-expansion states — Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming — only parents with very low incomes can receive full Medicaid benefits, according to the report.
Wisconsin expanded Medicaid up to 100% of the federal poverty level in 2014, while Georgia recently added work requirements for coverage.
If these 10 remaining states implemented expansion next year, Medicaid enrollment would increase by 5 million, with 2.3 million people eligible to switch from Affordable Care Act marketplace plans to Medicaid, where they would have lower cost sharing without deductibles.
About 536,000 people would transition from employer-sponsored coverage, and 133,000 currently enrolled in unregulated plans that don’t comply with ACA standards would move to Medicaid, the report found.
Fully broadening Medicaid coverage could be financially beneficial for states, according to the analysis. If the final 10 states expanded Medicaid, spending would increase by $1.5 billion, or 3%, partially offset by $457 million in state and local government savings on uncompensated care.
Additionally, under the American Rescue Plan passed in 2021, states that newly expand Medicaid would receive additional federal funds for two years.
“Expanding Medicaid eligibility would thus provide substantial health and economic benefits at little or no cost to state governments,” report authors Matthew Buettgens and Urmi Ramchandani wrote.
Federal spending on Medicaid and the ACA marketplaces would increase by about $24 billion, or 17.5%, partially offset by $731 million in savings on uncompensated care, the report found.
Medicaid expansion would also pare down the uninsurance rate among historically vulnerable groups. Non-Hispanic Black adults would see a 43.2% reduction in the uninsured rate, while reproductive-age women would experience a drop of 31% and young adults would see a decrease of 32.4%.
The latest analysis comes just after Medicaid enrollment reached record levels during the pandemic. But as states have resumed eligibility checks for the safety-net program, more than 9 million people have been removed from Medicaid, according to KFF.
More than 70% have had their coverage terminated for procedural reasons, or because they didn’t complete the renewal process, which could signal enrollees may still be eligible, according to the health policy research firm.
Last month, federal regulators ordered 30 states to pause procedural disenrollments of Medicaid beneficiaries after warning about a systems issue that could inappropriately remove children and other enrollees from the program.
