MedicalResearch.com Interview with:
Julie L. Hudson, PhD
Center for Financing, Access, and Cost Trends
Agency for Healthcare Research and Quality
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Since 2013, public coverage has increased not only among low-income adults newly eligible for Medicaid but also among children and adults who were previously eligible for Medicaid or the Children’s Health Insurance Program (CHIP). Recent research has shown that growth in public coverage varied by state-level policy choices.
In this paper we study the growth in public coverage (Medicaid/CHIP) for three population samples living in Medicaid Expansion states between 2013 and 2015: previously eligible children, previously eligible parents, and newly eligible parents by state-level marketplace policies (Note: eligibility refers to eligible for Medicaid/CHIP, eligibility for marketplace subsidized coverage). All marketplaces are required to assess each applicants’ eligibility for both the marketplace and for Medicaid/CHIP. States running state-based marketplaces are required to enroll Medicaid-/CHIP-eligible applicants directly into public coverage (Medicaid or CHIP), but states using federally-facilitated marketplaces can opt to require their marketplace to forward these cases to state Medicaid/CHIP authorities for final eligibility determination and enrollment. We study the impact of marketplace policies on public coverage by observing changes in the probability Medicaid-/CHIP-eligible children and parents are enrolled in public coverage across three marketplace structures: state-based marketplaces that are required to enroll Medicaid-/CHIP-eligible applicants directly into public coverage, federally-facilitated marketplaces in states that enroll Medicaid-/CHIP-eligible applicants directly into public coverage, and federally-facilitated marketplaces with no authority to enroll Medicaid-/CHIP-eligible applicants into public coverage.
Supporting the existing literature, we find that public coverage grew between 2013-2015 for all three of our samples of Medicaid-/CHIP-eligible children and parents living in Medicaid expansion states. However, we show that growth in public coverage was smallest in expansion states that adopted a federally-facilitated marketplace and gave no authority to the marketplace to enroll Medicaid-/CHIP-eligible applicants directly into public coverage. Additionally, once we account for enrollment authority, we found no differences in growth of public coverage for eligible children and parents living in expansion states that adopted a state-based marketplace versus those in states that adopted a federally-facilitated marketplaces with the authority to directly enroll Medicaid-/CHIP-eligible applicants
MedicalResearch.com: What should readers take away from your report?
Response: “No wrong door” policies were implemented to help increase health insurance coverage among low-income applicants, streamlining enrollment into the appropriate program (Medicaid, CHIP, or marketplace) regardless of where the applicant initially applied. Our results suggest that policies authorizing eligibility determination and enrollment coordination between the marketplace and Medicaid/CHIP programs may have been successful in increasing the probability that a Medicaid-/CHIP-eligible child or parent was enrolled in public coverage.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Federal and state policy for marketplaces, Medicaid, and CHIP have evolved since 2015. It is important to study the potential effect these policy changes could have had on insurance coverage for children and their parents.
MedicalResearch.com: Is there anything else you would like to add?
Response: Any opinions and conclusions expressed in the article or interview are those of the authors and do not represent views of the Agency for Healthcare Research and Quality or the Department of Health and Human Services.
Hudson JL, Moriya AS. Association Between Marketplace Policy and Public Coverage Among Medicaid or Children’s Health Insurance Program–Eligible Children and Parents. JAMA Pediatr. Published online July 16, 2018. doi:10.1001/jamapediatrics.2018.1497
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