Oct 30, 2023 - Health

As millions lose Medicaid, ACA sign-up season may help

Illustration of a net catching falling red crosses

Illustration: Sarah Grillo/Axios

Relatively few people who lost Medicaid coverage this year have wound up in Affordable Care Act plans — but the HealthCare.gov sign-up period starting this week could be a chance to enroll people who've fallen through the cracks.

The big picture: The ACA's health insurance markets, which offer heavily subsidized coverage for lower-income people, can provide a backstop for some of the millions who have been removed from Medicaid this year as states pare their rolls for the first time since the pandemic.

  • State health officials and health advocates are doubling down on their outreach strategies for this group over the next couple of months, when more people will be aware of their insurance options.

State of play: As of June — just two months after the "Medicaid unwinding" began — about 350,000 people who lost Medicaid coverage had enrolled through HealthCare.gov or a state-run insurance marketplace, according to the most recent federal data.

  • At around that time, more than 1.5 million people had been disenrolled from Medicaid because they no longer qualified or, in most cases, due to a procedural issue.
  • By last week, more than 9.5 million had been disenrolled from Medicaid, per KFF, so more people have enrolled in an ACA plan than the June data shows.
  • Additionally, some who lost Medicaid have likely enrolled in health insurance through work, though there isn't firm data yet.

What they're saying: Open enrollment is a way "to really throw the net as wide as we can" to attract people coming off Medicaid, Jessica Altman, CEO of California's insurance exchange, told Axios.

  • This year's open enrollment messaging in the state focuses on "bridging the gap," she said.
  • "We're bridging the gap of affordability, we're bridging the gap of quality and equity and health disparities," she said. "But also it's very geared towards: We're very literally bridging the gap between [Medicaid] and then keeping you on another coverage."

Context: The open enrollment season, which lasts from Nov. 1 to Jan. 16 on HealthCare.gov, isn't the only chance people who lost Medicaid have to sign up for an ACA plan. They can enroll at any time through July 2024 under a special enrollment period the Biden administration created in response to pandemic-era coverage protections ending.

Reality check: That message hasn't been reaching everyone who needs to hear it.

  • "There seems to be a misconception from some people coming off of Medicaid that they do have to wait for open enrollment" to get marketplace coverage, said Alex Sanchez, director of communications for New Mexico's state health insurance exchange.
  • By July, the exchange made 157,000 automated calls and sent 220,000 text messages, along with thousands of emails and personal calls, to people who lost Medicaid, she said.
  • The exchange continued to do outreach events in Spanish, online and in communities. It even had a booth outside the Duke City Marathon in Albuquerque earlier this month, Sanchez added.

There is some behind-the-scenes work that aims to help connect people with ACA coverage, too.

  • When a state determines someone is no longer eligible for Medicaid, it transfers their information to the Affordable Care Act marketplace, which may then reach out to let them know about coverage options.
  • HealthCare.gov, the federal marketplace, also helps coordinate outreach efforts to connect people who lost Medicaid with local "navigators" who can help them understand coverage options, said Jennifer Wagner, director of Medicaid eligibility and enrollment at the Center on Budget and Policy Priorities.
  • The 18 states that run their own health insurance marketplaces, plus Washington, D.C., can be more creative in their outreach efforts and sign-up incentives, Wagner noted.
  • New Mexico covers the first month's premium for many enrollees switching from Medicaid to marketplace coverage. California automatically enrolls certain people leaving Medicaid into marketplace coverage.
  • That's in addition to emails, texts, calls and "massive in-community media engagement and community conversations with community-based organizations [and] health care providers" during open enrollment, California's Altman added.

Yes, but: More than 70% of people disenrolled from Medicaid lost coverage because they missed renewal notices or failed to fill out paperwork and they aren't provided the same resources about getting marketplace coverage.

  • Many people don't know they've lost their coverage until they show up at the pharmacy or a doctor, said Cheryl Fish-Parcham, director of private coverage at advocacy organization Families USA.
  • "There still is a lot of outreach needed to let people know that, yes, they can enroll now," she said.

Editor's note: This story has been updated with Cheryl Fish-Parcham's new title.

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