Although most of the attention on health coverage enrollment is naturally focused on marketplace enrollment at this time of year, more Americans have gained coverage through Medicaid than the marketplace in the last two years. As of the latest data available, 13.5 million Americans have enrolled in Medicaid since October 2013, while 9.3 million Americans had active coverage through the marketplace.
This is driven primarily by enrollment in states than have extended Medicaid coverage to all adults with income up to 138 percent of the federal poverty level (currently about $16,240 for an individual or $27,720 for a family of three). These 29 states and D.C. account for 85 percent of the increased Medicaid enrollment since October 2013 (and don’t include Montana, where expansion began this month, and Louisiana, which is poised to implement its expansion in early 2016).
This is due in part to generous support made available to states that choose to extend Medicaid coverage to this population. The Affordable Care Act allows states that have chosen to extend coverage to these adults to receive “enhanced” federal matching funds to pay for this coverage; in fact, most states were eligible to get 100 percent of the costs of covering these individuals paid for by the federal government in 2014, 2015, and 2016. After that, federal support for the Medicaid expansion population is scheduled to gradually drop, although never below 90 percent.
The president’s proposed budget for 2017 will include an important provision to allow states to get 100 percent of the costs of their Medicaid expansion covered for the first three years, regardless of when the state begins its expansion. Making this assurance may make some of the remaining states that have not yet expanded more likely to take this step.
Nearly 3 million Americans are currently in the “coverage gap” — that is, they are ineligible for Medicaid or financial help through the Marketplace. Efforts like this one to make it more attractive for the remaining states to close the coverage gap are a critical part of maximizing the number of Americans who enroll in and retain coverage.