State-run health insurance marketplaces enroll more in Medicaid

By Annette M. Boyle

States that operate their own health insurance marketplaces tend to enroll more people in Medicaid than those states that rely on the federal marketplace to "assess and refer" individuals for state determination of Medicaid eligibility, according to a new analysis by The Commonwealth Fund.

States that run their own marketplaces and have expanded Medicaid eligibility had the highest enrollment rates, likely because these marketplaces require full integration of Medicaid enrollment into the marketplace enrollment process, the analysis suggessts.

Of the six states that had the highest Medicaid enrollment growth, three (Nevada, New Mexico and Oregon) have state-based marketplaces that use the platform. This indicates that a state-based marketplace simplifies communication between a state's Medicaid program and the broader insurance marketplace, regardless of the technology used, according to the analysis.

While the technology used does not appear to matter, the analysis indicates that integration of the determination for subsidies for private insurance or eligibility for Medicaid makes a significant difference. The report attribute generally higher rates of enrollment to elimination of an additional step--referral to the state Medicaid program--which may delay determination of eligibility. It also cites the technical challenges of transferring electronic files between the federal marketplace and state agencies.

Based on these findings, the analysis points out that Kentucky's decision to move away from the state-run Kynect marketplace to the federal marketplace may lead to a drop in Medicaid enrollment, particularly if the state chooses the "assess and refer" model. Along with Arkansas, Kentucky has seen the highest level of Medicaid growth of all states, with more than four times as many Kentuckians qualifying for Medicaid than marketplace subsidies.

To learn more:
- here's the analysis

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