Thursday, June 02, 2016

About that swift Medicaid expansion enrollment in Louisiana

[Updated 6/3, at bottom]

Yesterday, as Louisiana opened enrollment for those newly eligible for its Medicaid expansion, effective July 1, I noted that probably about 65,000 of the state's enrollees in subsidized private health plans via will be newly eligible. Also noted, via Charles Gaba: Governor John Bel Edwards claimed that 175,000 people were already enrolled as of yesterday.

Via contact with Louisiana's Dept. of Health & Hospitals, a few clarifying points:

1. Virtually all of those enrolled as of yesterday, a total of 189,000 by day's end, were transfers from existing limited-benefit public plans. These include 132,000 enrollees in Take Charge Plus, a program focused mainly on family planning, along with a few free office visits; and 56,000 from the Greater New Orleans Health Connection (GNOHC), a no-cost primary care program for low income people in the greater New Orleans area. GNOHC does not provide drug or hospital coverage.

2. Letters went out to enrollees in these programs in early May, inviting them to return a short form and enroll. Enrollees can choose from among several managed care Medicaid plans. Those who do not respond are assigned a plan and auto-enrolled.

3. These limited benefit plans were set up or expanded by health officials in the Jindal administration who anticipated that the Medicaid expansion's day would come and wanted to prepare the ground for the kind of swift enrollment in full-scale managed Medicaid now taking place.

4. The state is also getting a head start in targeting the still-uninsured through its ability to a) use SNAP data to determine income eligibility, and b) disregard medical data for backlogged applicants for disability-based Medicaid. Now, any of those applicants whose income qualifies them will be cleared for enrollment.

5. State officials are also taking advantage of "out-stationing" -- that is, enrollment assistance provided by hospitals and health clinics. Many facilities are taking advantage of a matching program: the facility puts up half the money to pay the assistance personnel and the federal government pays the other half. At present, more than 100 enrollment employees are at work in more than 75 provider locations.

6. State health officials are now focused on enrolling the uninsured. There is no planned outreach to private plan enrollees who are now eligible for Medicaid, nor is there a plan to transition them for 2017.
Update, 6/3: Though I made the point in the prior post, I think I should add again here that someone had better focus on newly Medicaid-eligible private plan enrollees at least by open enrollment season for 2017. Insurers in the state are requesting average weighted increases of 27%, according to Charles Gaba, and those who auto-enroll in their 2016 plans could be on the hook for large increases if their plan is anything other than the benchmark silver. More generally, almost anyone in the 100-138% FPL income range will be better off in Medicaid than in a marketplace plan. To repeat from the previous post:
Louisiana's ACA private plan marketplace thus stands to lose about one third of its enrollees. Most of them will probably find themselves better off under Medicaid, as focus group data from the Kaiser Family Foundation indicates. That's true even of the probable 85% or so of enrollees in this income range who bought silver plans and so accessed ACA Cost Sharing Reduction (CSR) subsidies. For buyers in the 100-138% FPL income range, a benchmark silver plan costs 2% of income, whereas Medicaid will have no premium. While the CSR-enhanced private plans are designed to cover 94% of the average user's medical expenses, out-of-pocket expenses under Medicaid are even lower, if they exist at all (I am seeking info on LA Medicaid cost-sharing, if any).

Of the perhaps 65-74,000 current Louisiana private plan enrollees now eligible for Medicaid, those who stand to gain the most are the roughly 15%** who chose to enroll in cheaper bronze plans. In New Orleans and Baton Rouge, bronze plans have deductibles ranging from $4,500 to $6750 for a single person and generally offer no services exempt from the deductible, excepting the ACA's mandatory free preventive care.


  1. Andrew
    On an unrelated subject, but because its your beat, I have a question about the Commonwealth Fund report out today. It was my understanding the number of folks with individual plans are about equal--12M each on and and off the exchange. Yet the percentage enrollment as per report (this is a paragraph summary):

    ...indicates a lopsided enrollment percentage. I would think the disparity would yield a much greater weighting in the FFMs. What gives?


    1. Brad, I haven't read the Commonwealth report yet, but Kaiser, in its just released indiv market survey, estimates that 64% of plans are now sold in the marketplace. The 36% outside includes noncompliant plans, so I guess they're not that far off the Commonwealth estimate, if the latter excludes noncompliant plans. Here's Kaiser: