KFF report: States have modernized Medicaid enrollment under ACA 

A new KFF report dives into ongoing enrollment trends in Medicaid. (Getty/designer491)

Medicaid eligibility has increased significantly, and enrollment has modernized under the Affordable Care Act, but whether those gains will continue remains an open question, according to a new report. 

The Kaiser Family Foundation released the latest edition of its annual survey examining eligibility, cost-sharing and enrollment in the Medicaid program, and found that the majority of states now offer enrollment powered by tech tools, far more than two decades ago. 

All 50 states and the District of Columbia allow online applications, while 47 states offer applications by phone and 38 allow people to apply using a mobile app. In addition, 33 states allow beneficiaries to monitor their plans by app. 


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A growing number of states also offer coverage determinations and renewals nearly immediately thanks to new tech tools, according to the report. Sixteen states process at least half of eligibility determinations within 24 hours, and 21 states complete at least half of renewals automatically. 

RELATED: The impact of ‘partial’ Medicaid expansion on coverage 

These modernized, streamlined processes weren’t limited to states that expanded Medicaid, KFF found, and were spurred at least in part by funding provided within the ACA for upgrades. 

“Prior to the ACA, many states relied on paper-based, manual enrollment processes with burdensome requirements that could take days and weeks in some states,” according to the report.  

“The ACA accelerated the adoption of new data-driven enrollment and renewal processes to connect individuals to coverage more quickly and conveniently and reduce the paperwork burden on states and individuals,” the researchers wrote. 

As of January, 36 states and D.C. have expanded Medicaid under the ACA, which has significantly boosted enrollment in the programs in those regions, according to the report. In the remaining 14 states, however, about 2.5 million people fall in to the “coverage gap,” where their income is too high for Medicaid but too low for tax credits on the exchanges. 

RELATED: Puerto Rico, other territories facing Medicaid ‘fiscal cliff’ with expiring ACA and disaster funds 

The report notes, however, that emerging policy approaches could strongly impact gains in coverage and modernization. On one hand, additional states are considering Medicaid expansion, which would boost coverage even in a “partial” approach that some are weighing. 

Conversely, though, a number of states are planning to add work requirements to their programs—just one, Arkansas, has rolled them out so far—and such requirements can both hinder coverage gains and add to the administrative burden in the program, according to the report. 

“These provisions require complex and costly documentation and administrative efforts that would likely increase barriers to coverage and lead to coverage losses among eligible individuals,” according to the report. 

KFF’s data backs up this thesis. In Arkansas, 18,000 people were removed from Medicaid enrollment between June and December, and in more than 90% of cases they were ineligible due to an administrative issue. 

Other factors to consider, according to the foundation, include the impact the ongoing immigration debate can have on enrollment; lower funding for outreach for ACA plans could also dampen Medicaid sign-ups. 

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