Overlapping Eligibility and Enrollment: Human Services and Health Programs Under the Affordable Care Act. Many consumers who will newly qualify for health coverage under the Affordable Care Act already participate in human services programs

12/23/2013

A core objective of the Affordable Care Act’s health programs is maximizing enrollment of the eligible uninsured. To achieve this goal, the most important groups to reach are likely to be newly eligible consumers—Medicaid-eligible childless adults, Medicaid-eligible parents with incomes above their state’s pre-ACA thresholds, and people who qualify for newly created Marketplace subsidies.

Health programs could use human services programs to identify such consumers who have already been found to meet many requirements of Medicaid and Marketplace subsidies. Figure 6 indicates the relative size of these newly eligible populations among consumers who receive or qualify for various human services programs. To address variations among state pre-ACA eligibility limits, we use as a rough proxy for adults who will newly qualify for Medicaid the combination of: (a) childless adults, who are ineligible for Medicaid regardless of income in most states; and (b) parents with incomes above 63 percent FPL, the pre-ACA median income eligibility threshold for working parents.17

The estimates of Medicaid eligibility in this section thus differ from those in the previous section. The latter included, in addition to the childless adults and parents who are analyzed in this section, both children and the poorest eligible parents.18 Put differently, while the previous section encompassed all Medicaid-eligible consumers, this section focuses on those who are likely to be newly eligible in 2014.

Clearly, the most productive overall human services programs, in terms of their capacity to help enroll newly eligible populations, are EITC, SNAP, and LIHEAP. If all states expand Medicaid eligibility, these programs will reach 40 percent, 39 percent, and 15 percent of newly eligible Medicaid adults, respectively; they also serve 21 percent, 3 percent, and 5 percent of people who will qualify for Marketplace subsidies (Figure 6). SNAP could play a particularly significant role reaching newly eligible adults, since it serves substantially more such adults than any other human services program.

Of an estimated 26.9 million childless adults who would qualify for Medicaid under expansion, SNAP reaches 9.4 million, or 35 percent—significantly more than the 6.9 million who qualify for EITC, the human services program that reaches the second-highest number of childless adults eligible for expanded Medicaid coverage in 2014 (data not shown). That said, SNAP may soon serve many fewer childless adults. Typically, non-disabled adults who do not reside in a household that includes a child must work an average of 20 hours per week or be limited to 3 months of SNAP eligibility in each 36-month period that they are not working. However, states may apply to waive this requirement in areas where there is high unemployment or a lack of jobs. Forty-six states have approved waivers of this special work requirement through September 30, 2013, the end of federal fiscal year 2013.19 It is not clear how broadly this exemption will continue after then, because of changing economic conditions, state decisions to opt out of the exemption, and possible changes to the SNAP statute.

In addition, child support enforcement programs work with noncustodial parents, many of whom will qualify for health coverage under the Affordable Care Act. If all states expand eligibility, noncustodial parents will include an estimated 8 percent of adults who will be newly eligible for Medicaid (measured using the proxy measure described above) and 6 percent of people who will qualify for Marketplace subsidies (Figure 6). Child support enforcement programs could thus make an important contribution to reaching the newly eligible uninsured.20

HHS’ Centers for Medicare & Medicaid Services (CMS) have authorized states to use SNAP records to enroll Medicaid-eligible consumers into coverage.21 In states that take such steps, Figure 7 shows the extent to which other human services programs could reach the remaining groups who will be newly eligible for health coverage. Not surprisingly, the most useful programs in reaching non-SNAP recipients who will be newly eligible Medicaid adults or who will qualify for Marketplace subsidies are likely to be EITC and LIHEAP, followed by programs that serve noncustodial parents.

Figures 6 and 7 suggest that unemployment insurance may also be helpful in reaching these populations. However, that may be a result of the time period from which the modeling results were taken. As explained earlier, our estimates are based on the 2011 CPS-ASEC, which reflects conditions during the 2010 economic downturn. It is not clear whether, under more favorable economic conditions, unemployment insurance will continue to reach as many people who will qualify for Medicaid, CHIP, or Marketplace subsidies.

 

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Among consumers under age 65 who will be newly eligible for health programs under the Affordable Care Act, the percentage who re

Newly eligible Medicaid adults (proxy) (n=34.5 million)People eligible for Marketplace subsidies (n=18.5 million)
EITC eligibles40%21%
SNAP39%3%
LIHEAP15%5%
Potentially eligible for unemployment insurance8%8%
Noncustodial parents8%6%
Housing7%1%
WIC6%4%
Subsidized child care1%0%
TANF0%0%

Figure 6. Among consumers under age 65 who will be newly eligible for health programs under the Affordable Care Act, the percentage who receive or qualify for various human services programs

Figure 6. Among consumers under age 65 who will be newly eligible for health programs under the Affordable Care Act, the percentage who receive or qualify for various human services programs

Source: TRIM3, HIPSM 2012. Notes: Assumes that all states expand Medicaid eligibility for adults to 138 percent FPL. Eligibility for Medicaid and CHIP includes children’s pre-ACA categories above 138 percent FPL. Proxy measure for newly eligible adults includes childless adults up to 138 percent FPL and parents with incomes between 63 percent FPL, the income-eligibility threshold for working adults in the median pre-ACA state, and 138 percent FPL. Estimates do not include people with disabilities who receive Medicare. Child care and WIC estimates include immediate family members of recipients. Unemployment insurance and EITC estimates are for potential eligibility and eligibility, respectively; other human services program estimates are for receipt. For more information about our methodology, see Appendix III.

Figure 7. Among consumers under age 65 who will be newly eligible for health programs under the Affordable Care Act and who do not receive SNAP, the percentage who receive or qualify for various other human services programs

Figure 7. Among consumers under age 65 who will be newly eligible for health programs under the Affordable Care Act and who do not receive SNAP, the percentage who receive or qualify for various other human services programs

Source: TRIM3, HIPSM 2012. Notes: See notes to figure 6.

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