January 30, 2015—About one-third of the people who were enrolled in Medicaid early last year under expanded eligibility guidelines in the health care law could have already been collecting benefits from the health program for the poor, according to an analysis of Medicaid data.
The statistics from the Centers for Medicare and Medicaid Services (CMS) illustrate how states that expanded Medicaid eligibility before the law was enacted in 2010 are getting expanded funding to sign up a population they already covered. The data also underscore how difficult it has been to establish precisely why the Medicaid population is growing.
States' ability to broaden eligibility for Medicaid is one of the linchpins of the health care law. The law allows states to broaden eligibility so that anyone whose income is up to 138 percent of the federal poverty line can qualify. Previously, people had to not only meet income requirements but also fall into certain categories, such as pregnant women, people with disabilities, children, and some parents of children.
The complexity of the rules about how to characterize people makes it difficult for states to ensure they are putting everyone in the right category—band getting paid appropriately.
"Making sure people go into the right grouping is a very high priority for the federal government and for states," said National Association of Medicaid Directors Director of Federal Policy and Strategy Andrea Maresca.
Earlier government data documented how the Medicaid population has grown since states began reaching out to people who would qualify under the health law's expansion, not how many in the expansion category were already eligible.
In January 2014, 36 percent of the people who were signed up under the expanded eligibility standards could have already been collecting benefits. By March 2014, about 32 percent of people who qualified under the new standards would have been eligible before the health law's Medicaid expansion was implemented on Jan. 1, 2014.
In New York, 96 percent of the people counted as part of the state's expansion population in January—763,341 of 791,665 residents—qualified under the state's pre-health law expansion. The figure was 95 percent in Delaware. And all the Massachusetts and Vermont residents counted in the expansion population were eligible before the law incentivized states to broaden Medicaid.
In all, nine states had at least 15,000 previously eligible people that CMS counted in the expansion category.
The details were in a package of tables that CMS released showing state-by-state data from the first three months of 2014. The tables do not detail how many eligible people were also previously enrolled.
The data is extracted from forms that states send to federal officials to get paid.
Some states got paid higher federal rates for groups of people that they had stopped enrolling. Arizona, for example, froze enrollment from July 2011 to December 2013, said Monica Coury, assistant director of the Office of Intergovernmental Relations for the Arizona Medicaid program. The state started re-enrolling some individuals when officials realized they could draw down a higher matching rate for that group than they previously got. Arizona now gets about an 85 percent matching rate, compared to an approximately 68 percent matching rate for people who qualified under guidelines before the health law expansion.
When Congress passed the law, it gave states that had already expanded their Medicaid programs higher matching rates, so they wouldn't be at a financial disadvantage to those states that waited until the law was passed, said Robin Rudowitz, associate director of the nonpartisan Kaiser Commission on Medicaid and the Uninsured.
The law puts the federal government on the hook for all the costs of people who qualify through the new expanded guidelines through 2016. The assistance then phases down until it is 90 percent of costs for those people in 2020.
States that expanded programs before the law's enactment don't get that much for their previously insured population but qualify for annual adjustments under a higher-than-usual matching rate. By 2020, all states will get a 90 percent matching rate for people enrolled under expanded eligibility guidelines.
"It's a significant savings for us. It really helps us out a lot," said Stephen M. Groff, director of the Delaware Division of Medicaid and Medical Assistance. "We're being rewarded for having done the right thing all those years ago."
Delaware will save about $80 million in the first year through the higher transitional rates, said Groff. The matching rate for people who are in the health law expansion category was about 77 percent last year, he said. The state got about a 55 percent rate for those people previously.
The recently-released tables show that some states that expanded Medicaid before the law experienced only modest growth in Medicaid in early 2014.
Less than 10,000 new people signed up in Delaware through Medicaid expansion in the past year. "It is not more than an incremental change for us," said Groff.
Other states that provided coverage to a broad group of adults before the health law passed are taking advantage of the highest federal reimbursements, which pay for 100 percent of costs through 2016. Minnesota, for instance, covered a broad adult population before the law was enacted but funded that program without any federal contributions, said a Minnesota Department of Human Services official. In 2014, costs were shifted to the federal government.
CMS said that Medicaid and the Children's Health Insurance Program grew by a net 9.7 million people in a year through October 2014. Federal officials are expected to release updated numbers soon.