New Medicaid members healthier than pre-expansion enrollees

Consumers who are newly eligible for Medicaid and those who were eligible before the Affordable Care Act was enacted but who are not enrolled are healthier than pre-ACA enrollees, according to a new Health Affairs study.

Researchers looked at data from 2005-2010, and found that 4.4 million adults were eligible but not enrolled, compared to 6.8 million nondisabled adults enrolled in Medicaid and 23.3 million newly Medicaid-eligible under the ACA's expansion.

They found adults who were newly Medicaid-eligible or pre-ACA eligible but not enrolled had equal or better physical and mental health than those who enrolled before the healthcare reform law was passed.

Moreover, newly eligible and pre-ACA eligible but not enrolled adults had lower rates of chronic conditions than pre-ACA enrollees. Even when looking at states not expanding Medicaid, the newly Medicaid-eligible were healthier than pre-ACA enrollees.

The findings suggest opt-out states could enroll a healthier Medicaid population than pre-ACA enrollees by changing their minds on expansion. That builds on a state-by-state analysis from the Commonwealth Fund that found Medicaid opt-out states would benefit most from the ACA's insurance reforms.

The researchers also noted that knowing the health status of newly eligible Medicaid beneficiaries could help determine what services those adults will need, as well as the potential cost to cover them.

While new Medicaid beneficiaries may be healthier, they need education about how to use their health plan effectively because they're confused about coverage and how to access different types of care, according to a February Health Affairs study. The analysis of Oregon's trial Medicaid expansion, which can apply to other states expanding Medicaid, found new enrollees rarely obtained healthcare because they didn't understand how the insurance worked, FierceHealthPayer previously reported.

As ACA implementation continues, states and insurers should be prepared to offer coverage stability for individuals who may move in and out of Medicaid eligibility as their financial situation changes. Researchers expect such churning to prove costly for insurers and states, while consumers end up with coverage gaps in their insurance.

For more:
- here's the Health Affairs study