Friday, January 15, 2016

Among the newly Medicaid-eligible in Louisiana: 50,000-plus private plan enrollees

Congratulations to poor and near-poor residents of Louisiana, whose new governor, John Bel Edwards, signed an executive order embracing the ACA Medicaid expansion, targeting July 1 as the implementation date.

And a gentle reminder to the state's healthcare officials that the estimated 300,000 Louisianians newly eligible for Medicaid will include about a third of those enrolled in private health plans through HealthCare.gov.

According HHS statistics, 47% of the 175,382 private plan enrollees for 2016 for whom income data is available had incomes between 100% and 150% of the Federal Poverty Level. At least two thirds of them, or 55,000, probably have incomes under 139% FPL and are thus Medicaid-eligible (and technically, no longer eligible for private plan subsidies, though they doubtless won't be taken away from those who don't switch). That number should grow before the end of Open Season on Jan. 31.

The transition has some extra urgency in Louisiana because silver plan selection among those who qualify for Cost Sharing Reduction subsidies, which are available only with silver plans, is a bit low in Louisiana compared to other poor states. While 83% of Louisiana enrollees for whom income data is available  have incomes that qualify them for CSR, only 59% of enrollees accessed the benefit -- that is, 75% of those eligible, compared to an average of 78.4% in the 38 states using Healthcare.gov.

While silver selection was probably higher among those with incomes low enough to newly qualify for Medicaid (for whom silver plans are much cheaper than for even modestly wealthier enrollees), probably about 20% of those 55,000 are in bronze plans.  In New Orleans that means, at best, a $4,500 single-person deductible, with no benefits kicking in before the deductible is reached except for the ACA's mandatory free preventive services. While those plans are likely to be free for many buyers with incomes below 139% FPL (that depends on age, and they're free for a 40 year-old), they're also pretty close to worthless.

It takes a lot of outreach to get enrollees to switch in midstream. Here's hoping Louisiana can get it done.

P.S. Please have a look at and like/share xpostfactoid's new Facebook page. I'm posting interesting healthcare news as I come across it there.

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