Whither the 70,000 Louisiana marketplace enrollees who are newly Medicaid eligible?

Louisiana's Medicaid expansion continues apace, with a bit over 250,000 state residents gaining coverage since the program went live on July 1. As I noted in a prior post, most of those enrollees, about 190,000, were transferred from existing public limited-benefit plans. At present, about 2,500 people per day are enrolling. The state is aiming for about 375,000 new enrollees overall.

According to Andrew Tuozzolo, Chief of Staff at the Louisiana Department of Health, that target does not include enrollees in ACA marketplace plans rendered newly eligible for Medicaid. (In states that refused to implement the ACA Medicaid expansion, which included Louisiana until this year, eligibility for private plan subsidies begins at 100% of the Federal Poverty Level. In expansion states, residents with incomes up to 138% FPL are eligible for Medicaid, and not for private plan subsidies.)

Thanks to enrollment data released by CMS early this month, we now know that almost 85,000 Louisianans who had enrolled in private plans in the ACA marketplace as of the end of Open Season on Jan. 31 -- 40% of all enrollees -- reported incomes in the 100-138% FPL range. Most of those 85,000, though not all, should now be eligible for Medicaid, the chief exceptions being legally present noncitizens subject to the federal "five-year" bar to Medicaid eligibility.  About 15% of the state's marketplace enrollees had dropped out (or in most cases, probably, never paid a premium) as of March 31.  Most likely, then, about 70,000 current private plan enrollees are now Medicaid eligible (as well as perhaps 10-15,000 dropouts).

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 HealthCare.gov 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.

Among 375,000 Louisianans newly eligible for Medicaid: 75,000+ Marketplace enrollees

[see updates at bottom and followup re immediate Medicaid enrollments]

Congratulations to Louisiana for kicking off enrollment in Medicaid under its newly enacted ACA Medicaid expansion today. Enrollment begins today and is effective July 1.

The state estimates that 375,000 residents are newly eligible for Medicaid under the program. According to HHS, the state will be the first in the nation to use food stamp (SNAP) data to determine eligibility and enroll people in Medicaid. The Medicaid program has a dedicated website, Healthy Louisiana, that makes online enrollment at least look easy. On the phone, though, I got stuck in impenetrable feedback.loops calling the number there and on the state Dept. of Health & Hospitals website trying to get a live person (there is no media information number listed on either site). I suspect that outgoing GOP governor Bobby Jindal's massive cuts to government agencies has something to do with that.

One subset of newly eligible potential Medicaid enrollees that causes some inevitable disruption in states that belatedly accept the ACA Medicaid expansion is people currently enrolled in ACA marketplace plans whose income now qualifies them for Medicaid.

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.

Ripples in the ACA risk pool

When a state that initially refused to implement the ACA Medicaid expansion embraces it, that's great news for state residents who were in the so-called "coverage gap" -- earning too little to qualify for subsidized private plans in the ACA marketplace, but denied the Medicaid coverage which the ACA had originally mandated for them, before the Supreme Court rendered the expansion optional for the states.

For another income group, those with household incomes between 100% and 138% of the Federal Poverty Level (FPL), the expansion may be a blessing for some but not all. People in this income range are eligible for subsidized private plans in states that have refused the Medicaid expansion -- but for Medicaid only in states that implement it.

As of the end of the ACA's last "open season" enrollment period in February 2015, 22 states had not yet adopted the law's Medicaid expansion, and one state, Indiana, had just adopted it, effective February 1.  In those states, about one third of enrollees in private health plans purchased in the ACA marketplace had incomes in the 100-138% FPL range and so would have been eligible for Medicaid if their states had embraced the expansion.  They constitute perhaps 15-20% of all enrollees in the ACA private plan plan marketplace.

Red state attitudes toward the ACA: like America's, but more so

Update, 4/25:  see next post re the high rate of pre-existing conditions reported by respondents to this poll.

A New York Times/Kaiser Family Foundation poll released yesterday probes perceptions of the Affordable Care Act in four red states, Arkansas, Kentucky, Louisiana and North Carolina. * In all of these states, Obama's approval rating is in the 30s, and the ACA is also deep underwater, with approval/disapproval percentages ranging from 29/62  in Arizona to 38/54 in North Carolina.*

Those overall judgments, stoked by five years of relentless Republican denunciations and a barrage of negative advertising in recent months, are stark.  And yet, the underlying attitudes revealed in the poll's internals are strikingly congruent in key respects to the attitudes toward prospective healthcare reform recorded nationally in a Kaiser poll conducted in December 2008, when approval for a president-elect who had campaigned on a national healthcare overhaul was sky-high. 

In both polls, majorities opposed simply maintaining the pre-ACA status quo -- doing little or nothing to expand coverage in 2008, repealing the ACA today. In both, majorities favored government action to make health insurance available to people who could not get it from their employers. In both, majorities supported expanding Medicaid.  Yet in both, majorities rejected the notion that it was the federal government's responsibility to make affordable healthcare coverage available to all Americans.