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Expanding Medicaid the hard way

A lot smaller than it should have been, but it’s still something.

It's constitutional - deal with it

It’s constitutional – deal with it

More than 80,000 additional Texans have enrolled in Medicaid or the Children’s Health Insurance Program since the rollout of the Affordable Care Act last fall despite Republican state leaders’ decision not to expand eligibility to poor adults, according to federal figures.

The 80,435 new enrollees as of May — mostly Texans who already qualified for coverage but did not previously seek it — represent a 1.8 percent increase over pre-Obamacare figures. That places Texas, which has the nation’s highest uninsured rate, in the middle of the pack among states that chose not to expand access to those programs to everyone under 138 percent of the federal poverty line under the president’s signature health law. The expansion, a key tenet of Obamacare, was deemed optional by the U.S. Supreme Court.

This “woodwork effect” or “welcome mat effect” — in which people hear about Medicaid expansions around the country and learn they qualify in Texas — has not been huge. Roughly 874,000 Texans eligible for Medicaid or CHIP have still not enrolled, according to Kaiser Family Foundation estimates. That includes more than 700,000 children, said Christine Sinatra, state communications director for Enroll America, a group seeking to get the uninsured covered under the federal health law.

Stephanie Goodman, spokeswoman for the Texas Health and Human Services Commission, said her agency started seeing enrollment rates rise a couple of years ago, when the conversation on Obamacare was heating up. After the act took effect, and parents took to the federal marketplace to purchase private insurance plans, many discovered that their children were eligible for Medicaid, Goodman added.

[…]

Get Covered America and Enroll America, which are leading the charge to bring more people into the coverage fold across the country, also cited the Affordable Care Act’s simplification of the sign-up process as a driver of Texas’ recent enrollment growth, which took off in the spring.

And though Texas leaders did not expand Medicaid, the criteria for eligibility here and elsewhere did broaden slightly: The act raised from 21 to 26 the age at which people formerly in the foster care system have to give up their Medicaid coverage.

Absent the Medicaid expansion that Texas chose not to join, Medicaid and CHIP eligibility in the state is generally limited to members of several vulnerable groups, including children under 200 percent of the federal poverty line and some low-income seniors, pregnant women and parents, Sinatra said.

Texas has historically put up a lot of obstacles to enrollment in Medicaid and CHIP. In addition to the exceedingly stingy income requirements, there has been a six-month enrollment period at times, meaning you have to sign up twice a year. The state, and in particular the Republican leadership, does all this in a deliberate effort to keep enrollment down, since that allows for less spending. By the state, anyway – sucks to be you, counties and hospital districts. I for one would consider it justice if every currently eligible person managed to get themselves enrolled, however much it wound up costing the state. We’d be far better off overall regardless of the price. Texas Leftist has more.

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