Overlapping Eligibility and Enrollment: Human Services and Health Programs Under the Affordable Care Act. Data from health programs could help establish eligibility for human services programs


Most human services programs are capped. This means that serving new people may require displacing current clients. The expansion in health coverage contemplated by the Affordable Care Act can nevertheless help these programs more effectively and efficiently determine eligibility. Several years after the ACA has been implemented, numerous human services applicants and recipients may have had their circumstances evaluated by health coverage programs. If so, human services programs could borrow from this work that health programs have already done, allowing human services eligibility to be determined more efficiently than in the past. Ultimately, this could help both capped and uncapped human services programs alike.

We find that the vast majority of human services program participants will qualify for health coverage. If all states implement the Affordable Care Act’s Medicaid expansion, Medicaid and CHIP eligibility will reach 97 percent of SNAP recipients, 85 percent of WIC families, 99 percent of TANF recipients, and 87 percent of LIHEAP recipients under age 65 (Figure 1). This suggests that, once the ACA’s expansions are fully implemented, human services programs may be able to expedite eligibility determination for numerous applicants and participants based on data from health programs.

Two limitations of this analysis are important to acknowledge. First, this information shows the potential reach of health programs. That is, we show the number of human services participants who will qualify for Medicaid, CHIP, and Marketplace subsidies if states expand Medicaid eligibility. Human services programs will not fully benefit from health programs until the latter have had time to ramp up enrollment among new eligibles.

Second, much of the verification that health programs will receive from a new federal data hub cannot be shared with human services programs.4 For the latter to benefit from health agencies’ findings, it will be important to confirm that health programs can share their final eligibility determinations—for example, that a particular person has been found to have income at a certain percentage of the FPL—even if they cannot provide human services programs with all the verification on which such determinations are sometimes based.

Figure 1. Among recipients of various human services benefits under age 65, the percentage who will qualify for health programs under the Affordable Care Act

Figure 1. Among recipients of various human services benefits under age 65, the percentage who will qualify for health programs under the Affordable Care Act

Source: TRIM3, HIPSM 2012. Notes: Assumes that all states expand Medicaid eligibility for adults to 138 percent FPL. Children’s eligibility for Medicaid and CHIP includes pre-ACA categories above 138 percent FPL and does not exclude ESI recipients. Estimates for children and adults include people with disabilities who receive Medicare. WIC and child care counts include spouses and dependents under age 19 who do not directly receive subsidies. Housing subsidies include public housing and rent vouchers. For more information about our methodology, see Appendix III.

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