This article was originally published in Spotlight on Poverty and Opportunity.
Given the obstacles faced by the Affordable Care Act (ACA) over the past year, the widely-heralded 8 million signups through the federal and state health insurance marketplaces is a remarkable achievement. But it’s also worth emphasizing another accomplishment: the additional 6 million new low- and moderate-income people enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) — an especially impressive figure considering the number of states opting out of the Medicaid expansion. The ACA health insurance expansion’s first-year success was not an accident. Easier enrollment procedures for Medicaid and CHIP as well as on-the-ground assistance played vital roles in connecting millions of Americans with affordable health insurance.
Even before its expansion under the ACA, Medicaid was not reaching a wide swath of people it was intended to help. A 2010 article in the New England Journal of Medicine estimated that only 62 percent of adults who were eligible for Medicaid were enrolled in the program. Thanks to the health reform “welcome mat,” even in states that declined the expansion, more low-income families and individuals applied for coverage, and for many, the application process was significantly easier than in the past. Plus, there was more in-person help available for those who needed it.
The ACA instituted changes to make the Medicaid enrollment process more straightforward. These reforms include requiring states to use a single, streamlined application and adopt simpler rules around determining income, and prohibiting states from using asset tests or in-person interview requirements to keep people out. Now, family members in a household are able to connect to the programs for which they’re eligible using a single form, and they can apply online, by phone, or using a paper application. Other strategies that accelerate Medicaid, like fast-track (using data from other programs like the Supplemental Nutrition Assistance Program [SNAP] to verify Medicaid eligibility) and presumptive eligibility (in which hospitals and other organizations can enroll consumers on the spot), are making enrollment easier than ever.
Thanks to greater use of electronic verification, many consumers no longer have to provide paperwork to verify information that is already available on state and federal databases. These procedural changes were supplemented by active outreach efforts to connect with potential enrollees and answer any questions they had about their health insurance options. For instance, the ACA created a navigator program, in which trained individuals help consumers understand their insurance options and enroll. Additional funding has allowed community health centers, where many uninsured Americans receive their medical care, to expand their outreach and enrollment efforts.
At the same time, our organization — Enroll America — has been active in marshalling private funding to supplement and assist these outreach efforts. During the open enrollment period, our grassroots campaign — Get Covered America — had more than 200 staff and 30,000 volunteers donating their time in communities across the nation and working with local partners to ensure consumers were armed with the information they needed to access the new health insurance options available to them. These staff and volunteers have taken their message to community centers, local places of worship, and even door to door. Our mission has been to maximize the number of uninsured Americans who enroll in health coverage made available by the ACA, whether that coverage comes through private plans on the new health insurance marketplaces, or through Medicaid and CHIP. We actively reach out to all the uninsured — including the Medicaid and CHIP-eligible population — and encourage them to apply.
These outreach efforts have paid dividends. According to a June 2014 report by the Centers for Medicare and Medicaid Services, Medicaid enrollment grew 10.3 percent during the ACA open enrollment period. Not surprisingly, the rate of growth was higher in states implementing the Medicaid expansion, but even those states who had opted out saw an average increase of 3.3 percent. And of course, Medicaid and CHIP enrollment continue year-round, and we expect to see continued enrollment growth in the coming months.
As a nation, we’ve made significant progress toward guaranteeing health insurance to all Americans. Increasing enrollment in Medicaid and CHIP through simplified application procedures and on-the-ground assistance are a key part of that success story.
Still, there is much work to be done. Too many of our most vulnerable still don’t know about their health insurance options, and there is room for improved coordination between Medicaid agencies and marketplaces. For our part, Enroll America will not slow down our outreach effort on Medicaid and CHIP enrollment during the interim period, but will continue to encourage those in most need to enroll in affordable health coverage. Whether it’s hosting phone banks, knocking on the doors, or partnering with small businesses and community leaders, our staff will continue to build on the success of this enrollment period.
We always knew that ensuring all Americans have access to quality, affordable health care wouldn’t be a quick or easy process, and we’re dedicated to seeing that mission through in the months and years ahead.