Reasons for the wide variation in Medicaid participation rates among states hold lessons for coverage expansion in 2014

Health Affairs
Benjamin D SommersArnold Epstein

Abstract

The Affordable Care Act will expand Medicaid eligibility in 2014 to adults with incomes of up to 133 percent of the federal poverty level. To maximize this opportunity, policy makers need to ensure that participation, or "take-up," among eligible adults exceeds current rates. Using the Current Population Survey 2005-10, we estimated that the nationwide Medicaid participation rate was 62.6 percent among eligible adults ages 19-64 without private insurance. Take-up varied widely by state, from 43.0 percent in Arkansas and Louisiana to 82.8 percent in Massachusetts, after adjusting for population demographics. Participation was highest among disabled adults, 75.8 percent, and lowest among childless adults, 38.3 percent. Factors linked to higher take-up rates included low cost sharing for beneficiaries; more generous benefits; and greater use of managed care programs for Medicaid populations. Factors associated with lower take-up rates included the existence of asset tests in some states. Massachusetts's health reform was associated with a major increase in Medicaid participation. Our results suggest that when Medicaid is expanded in 2014, take-up may be less than anticipated because new enrollees will be offered a more restrictive...Continue Reading

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Citations

Jul 6, 2013·Cancer Causes & Control : CCC·Jennifer S SmithBaretta R Casey
Jul 26, 2013·The New England Journal of Medicine·Benjamin D Sommers
Sep 14, 2013·American Journal of Public Health·Julia Zur, Ramin Mojtabai
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Nov 20, 2014·Administration and Policy in Mental Health·Mir M AliBeth Han
Jun 4, 2014·The Milbank Quarterly·Heidi AllenLauren Broffman
Dec 10, 2014·Research in Social & Administrative Pharmacy : RSAP·Jonathan Hirohiko Watanabe, John P Ney
Jul 10, 2013·Journal of Health Economics·Benjamin D Sommers, Donald Oellerich
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Jan 8, 2014·Health Affairs·Benjamin D SommersArnold M Epstein
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Mar 20, 2021·Health Economics·Benjamin W Cowan, Zhuang Hao

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