The swelling rolls for Medicaid and the Children's
Health Insurance Program (CHIP) reflect both an expansion of
Medicaid under Obama's Affordable Care Act (ACA) and what healthcare
policy analysts call an "out-of-the-woodwork effect," in which
people who heard about Obamacare sought to obtain health insurance
and discovered that they had qualified for Medicaid even before the
law expanded eligibility.
"We have people who for the first time will have some health
security that they never had before," Kathleen Sebelius, secretary
of the Department of Health and Human Services, said of the Medicaid
numbers at the winter meeting of the U.S. Conference of Mayors in
It was not clear how much credit goes to the healthcare law,
"What many people don't read far enough to learn is that this number
also can include people in some states who are eligible under
pre-expansion — the woodwork effect — and whose Medicaid
enrollment was simply renewed," said Matt Salo, executive director
of the National Association of Medicaid Directors.
The 6.3 million people determined eligible for Medicaid or CHIP last
fall swamps the 2.2 million people who had purchased private health
insurance on the state-based Obamacare marketplaces that launched on
October 1. The ACA also raised the income threshold for Medicaid
eligibility to 138 percent of the federal poverty level, or $15,856
for a single person.
A Supreme Court decision in 2012 allowed each U.S. state to decide
whether to accept the expansion. So far, 25 states have reached an
agreement with the administration to do so. Prior to the ACA, just
over 60 million Americans were covered by Medicaid.
In December alone, 2.3 million individuals were determined eligible
to enroll in Medicaid or CHIP, an increase of over 20 percent from
November, according to the report from the Centers for Medicare &
Medicaid Services (CMS), the lead Obamacare agency. About 1.2
million of these were in the 25 states (and the District of
Columbia) already expanding Medicaid, and just over 1 million were
in the 25 states that have not.
The CMS figures refer to the number of people that meet Medicaid
eligibility rather than actual enrollment in the program due to the
troubled HealthCare.gov website, which is run by the federal
government to serve Obamacare sign-ups in 36 states.
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For months, the website did not correctly transmit information
that applicants are eligible for Medicaid to their state Medicaid
program. The state offices do the actual enrollment, and have been
scrambling to send out tens of thousands of letters to residents to
actually enroll them, the Washington Post reported this month.
At the same time, the national figures mirror what many of the
Medicaid-expansion states have reported. In California, for
instance, 625,000 individuals have gained coverage through private
policies purchased on the state's Obamacare exchange, Covered
California, while 1.2 million enrolled in Medi-Cal, the state's
The websites through which people can shop for insurance under
Obamacare are required to have what the Obama administration calls a
"no wrong door" policy, meaning that even if people went to their
state's exchange expecting to buy private insurance, the site would
determine if they were instead eligible for Medicaid or CHIP, which
generally charge zero premiums.
Several states have gone beyond that, seeking out Medicaid-eligible
people by contacting those who receive food stamps or other benefits
that indicate they have very low incomes.
(Reporting by Sharon Begley and David
Morgan; editing by Amanda Kwan)
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