Using Behavioral Economics to Inform the Integration of Human Services and Health Programs under the Affordable Care Act . Background

07/21/2014

Many eligible people do not participate in SNAP and Medicaid. In 2010, an estimated 75 percent of eligible people received SNAP with participation levels varying greatly by subpopulation, ranging from 92 percent for children and 90 percent for people with incomes below 100 percent FPL (who qualify for the highest benefit levels), to 67 percent for non-disabled childless adults, 65 percent for people in working families, and 35 percent for the elderly (figure 1).11 Participation rates across states varied as well, with a low of 55 percent of eligible people enrolling in California.12

In 2011, the average Medicaid/CHIP participation rate among children was 87 percent nationwide, with rates ranging from under 75 percent in Nevada, Utah, and Montana to 95 percent or above in Vermont, Massachusetts and Connecticut.13 Medicaid participation levels among adults, who are the target of the ACA Medicaid expansion, lagged far behind children’s, averaging  67 percent among adults who qualified under 2009 rules (figure 2).14

Figure 1. The Percentage of Eligible Individuals Receiving SNAP Benefits within Various Groups, FY 2010

Figure 1. The Percentage of Eligible Individuals Receiving SNAP Benefits within Various Groups, FY 2010

Sources: Eslami, et al., Cunnyngham, 2012.

Figure 2. The Percentage of Eligible Children and Adults Receiving Medicaid Nationally and in the Highest- and Lowest-Ranking States, 2009

Figure 2. The Percentage of Eligible Children and Adults Receiving Medicaid Nationally and in the Highest- and Lowest-Ranking States, 2009

Source: Kenney, et al., 2012. Note: The highest ranking state for children is defined as the state with the highest percentage of eligible children who are enrolled in Medicaid. Similar definitions apply to the lowest-ranking states and to adults. Estimates for 2009 are used in this figure to allow comparisons between children and adults. As noted earlier in the text, more recent estimates for children’s coverage show higher participation levels than in 2009.

If these benefits are valuable and available free of charge, why do so many eligible people fail to sign up? Both traditional neoclassical economics and more recent findings of behavioral economics suggest possible answers.


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