Overlapping Eligibility and Enrollment: Human Services and Health Programs Under the Affordable Care Act. Many eligible nonparticipants in uncapped human services programs will qualify for health coverage

12/23/2013

Health programs offer the potential to provide additional help to uncapped human services programs—that is, programs that serve all who qualify, without funding caps—by enabling them to reach eligible nonparticipants. SNAP is an uncapped program that has made extraordinary strides in recent years, modernizing program administration to improve program participation, lower error rates, and increase efficiency.5 From 2002 to 2010, the percentage of eligible individuals receiving benefits rose from 54 percent to 75 percent.6 Nevertheless, in some states and demographic groups, many eligible households remain unserved. California’s SNAP program, for example, reaches only 55 percent of eligible people;7 and among childless adults and working families, only 67 and 65 percent of eligible individuals, respectively, receive aid.8

If all states expand Medicaid eligibility, 88 percent of people who qualify for but do not receive SNAP will be eligible for insurance affordability programs, including 80 percent who will qualify for Medicaid or CHIP (Figure 2). Health programs may be particularly useful in helping SNAP reach two groups with below-average participation levels: childless adults and people with incomes above poverty. Among members of these two groups, 85 percent and 79 percent, respectively, will qualify for ACA health coverage (Figure 3).

EITC, another uncapped program, reaches an estimated 75 percent of eligible taxpayers.9 Among taxpayers with children who qualify, 81 percent claim the credit, but only 56 percent of eligible taxpayers without children receive it.

Insurance affordability programs may be able to help EITC outreach campaigns reach such eligible non-claimants. Altogether, 86 percent of people under age 65 who are eligible for EITC will qualify for health programs if all states expand Medicaid, including 84 percent of EITC-eligible childless adults (Figure 4).

It is worth noting, in this context, that a particularly underserved group of EITC-eligible taxpayers consists of childless adults with incomes too low to claim the full credit—that is, those with earned income between $1 and $6,200 a year, or 56 percent FPL for a one-person household in 2012.10 Not only does the low credit amount for which they qualify reduce these adults’ incentive to claim it, they are less likely than other taxpayers to file for other reasons, such as to obtain a refund or to meet legal requirements for filing tax returns; in 2012, for example, one-person households were not required to file unless their gross income was at least $9,750. As a result, it is not surprising that only 46 percent of such adults claim EITC.11 Almost all of this highly underserved group will qualify for Medicaid under expansion.

In terms of the final uncapped human services program that we examine in our microsimulation, unemployment insurance (UI), health programs will reach 62 percent of eligible individuals (Figure 5)—a smaller proportion than for the programs discussed earlier, but still representing more than three in five people who potentially qualify. As with EITC, it is worth emphasizing that we estimate the prevalence of consumers eligible for health programs only among people who are eligible for UI, regardless of whether they participate.12 It is also important to note that the estimates we present reflect UI eligibility during calendar year 2010, when the country was experiencing a severe economic downturn. The profile of UI-eligible consumers could be quite different under more favorable economic conditions.

More broadly, these estimates show the prevalence of insurance affordability program eligibility among people who qualify for SNAP, EITC, and unemployment insurance. They thus suggest the potential that health coverage could offer in reaching eligible populations not served by these uncapped human services programs. But we do not yet know, among consumers who will newly qualify for Medicaid or Marketplace subsidies, how many will enroll. In particular, we do not know the extent to which health programs will successfully enroll the very groups that SNAP, EITC, and unemployment insurance have had particular difficulty reaching. Human services program administrators and advocates will need to track carefully the progress of health programs in enrolling these populations over the next few years.

Figure 2. Health program eligibility among all people under age 65 who qualify for but do not receive SNAP

Figure 2. Health program eligibility among all people under age 65 who qualify for but do not receive SNAP

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. For more information about our methodology, see Appendix III.

Figure 3. Health program eligibility among two groups of people under age 65 who qualify for but do not receive SNAP

Figure 3. Health program eligibility among two groups of people under age 65 who qualify for but do not receive SNAP

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. For more information about our methodology, see Appendix III.

Figure 4. Health program eligibility among various groups of EITC-eligible people

Figure 4. Health program eligibility among various groups of EITC-eligible people

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. For more information about our methodology, see Appendix III.

Figure 5. Health program eligibility among people who potentially qualify for unemployment insurance

Figure 5. Health program eligibility among people who potentially qualify for unemployment insurance

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 children’s pre-ACA categories above 138 percent and does not exclude ESI recipients. Estimates for children and adults include people with disabilities who receive Medicare. For more information about our methodology, see Appendix III.

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