Tuesday, July 28, 2015

Pennsylvania Medicaid expansion enrollment jumps; have newly Medicaid-eligible 2014 private plan enrollees jumped with it?

Pennsylvania's somewhat rocky Medicaid expansion, for which enrollment began on December 1 and coverage on January 1, seems now to be firing on all burners. The state's Department of Human Services reported last week that enrollment is up to 439,000, more than two thirds of the state's target of 605,000.

The expansion began slowly. After Pennsylvania declined to expand in 2014, then-Governor Tom Corbett negotiated with HHS to create the kind of "private option" expansion popular with Republican governors. The "Healthy Pennsylvania" plans that were hastily constructed in fall 2014 had different terms for Medicaid-eligibles at different income levels, and eligibility criteria different from the state's existing programs. Adding to the confusion, existing state Medicaid programs required applicants to list their assets as well as their income; the ACA excludes such information from the Medicaid application process. Systems snarled and applications backlogged, though not as radically as in many states.

A transition back to traditional Medicaid initiated by the state's new Democratic Governor, Tom Wolf, kicked off on April 27. That transition will be complete by the end of this month, though some "private option" enrollees will be double-enrolled until September 1. By late April most applications were being processed in a timely manner, meeting the state's 30-day standard, enrollment counselors told me at the time.  Kait Gillis, a DHS spokeswoman, tells me that 150,000 have been enrolled since the transition to traditional Medicaid kicked off.

As I've noted before, enrollment statistics for Pennsylvania released in March by the federal Department of Health and Human Services seemed to indicate that a large number of Pennsylvanians who were enrolled in subsidized private plans in 2014 and became newly eligible for Medicaid when the state embraced the expansion for 2015 may not have made the transition and disenrolled. In brief, DHS's Gillis told me that CMS had prepared a list of some 175,000 individuals in 141,000 households who were enrolled in private plans at the end of 2014 and were deemed likely eligible for Medicaid in 2015 -- while HHS statistics indicated that fewer than 50,000 2014 enrollees at any income level had disenrolled as of the end of open season in mid-February.

On the other hand, as I recently reported, the overall income distribution of Pennsylvania's 2015 enrollees (as revealed in HHS data released in July) looks more like that of an "expansion" state than a "nonexpansion" state, as only 28% of enrollees had incomes between 100% and 150% of the Federal Poverty Level. In the 21 "nonexpansion" states using healthcare.gov, 44% of enrollees had incomes in that range, versus just 20% for expansion states on the platform. That's because eligibility for subsidized private plans in nonexpansion states begins at 100% FPL, versus 138% in expansion states.

The updated Medicaid enrollment numbers reinforce the impression that the bulk of 2014 private plan enrollees who became Medicaid-eligible this year may have eventually made the transition. On the other hand, HHS reported that more than 160,000 of Pennsylvania's 2014 private plan enrollees "auto-enrolled" in their existing plan or a replacement plan supplied by their insurer in 2015. And if that CMS list of likely Medicaid-eligibles was on target, almost half or more than half of the state's 2014 private plan enrollees became eligible for Medicaid in 2015.

If a substantial number of current private plan enrollees are in fact Medicaid-eligible, many may owe a substantial amount of money at tax time in 2016. That's because the state's cheapest silver plan last year, very popular among low-income buyers because it was way cheaper than the benchmark second-cheapest silver plan, went way up in price in 2015 (I sketched out the dynamics here). At the same time, the new benchmark plan has a lower premium than last year's, which means subsidies went down. And payments for auto-enrollees may not have been adjusted accordingly. 

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