Medicaid Expansion: Enrollment to Date

In just the first few months of new coverage under Medicaid expansion, we are seeing significant enrollment levels and evidence that thousands of Montanans need (and are now receiving) affordable health insurance. This month, the Montana Department of Public Health and Human Services (DPHHS) released new data on the number of people who have enrolled through the Montana Health and Economic Livelihood Partnership (HELP) Act. Since enrollment began on November 2 (with coverage beginning on January 1), over 36,320 Montanans have signed up, exceeding first-year projections on all levels.

This week, we will release a new report analyzing this enrollment and the populations that the state should consider focusing future outreach efforts. The report will also detail a number of successful strategies that other states have deployed to reach eligible families and get them enrolled.

As a preview of this work, here are some of our thoughts so far on enrollment.

Income levels

It is not surprising that Montana has seen a significant portion of newly enrolled individuals at very low incomes. So far, over 60 percent (or approximately 22,000) of those enrolled are living with family incomes below 50 percent of the federal poverty line. For an individual, this represents an annual income of $5,990, or about $490 per month. These are families that, in the past, have had few or no options for affordable coverage. The state and other partner organizations did incredible work to reach these populations using existing data and let them know they would be eligible for new health care coverage options in 2016.

We know that a significant percentage of the uninsured population below 50 percent has now enrolled; future enrollment efforts may be best targeted to populations with incomes between 50 and 138 percent of FPL. This population will be enrolled in the HELP Plan and subject to premiums and copays, so it is critical that the state’s materials are clear on what these premium levels are and the importance of gaining health insurance.

American Indians

While we have seen over 4,300 American Indians enroll, this number is low compared to the estimated percentage of the entire eligible population that is American Indian. According to Census data, American Indians represent nearly 20 percent of the total eligible uninsured population. And yet, only 12 percent of newly enrollees are American Indian.

Outreach efforts focused on eligible American Indians must take into account the unique health care dynamics, including how insurance relates to accessing services through Indian Health Service (IHS), tribal health clinics, and urban Indian health clinics. The state should work closely with tribal leaders and tribal advocates to ensure enrollment is supporting this existing tribal healthcare infrastructure. These types of partnerships are happening across the state, but even more can be done to support health coverage enrollment in Indian country.

Regional differences

We are seeing regional health departments and health centers actively engaged in enrollment efforts across the state, but enrollment numbers show opportunities to expand efforts in certain areas. Over 56 percent of enrollment has occurred in the top five counties in Montana (Cascade, Flathead, Gallatin, Lewis & Clark, Missoula, and Yellowstone counties). And while all five counties are reaching significant numbers of newly eligible, Gallatin County is lagging behind the other counties when comparing enrollment as a percent of eligible uninsured population.

MBPC commends the state, those engaged in Cover Montana, and others involved in enrollment efforts. The need for the HELP Act is clear – with over 36,000 Montanans accessing coverage in just the first couple months.

But thousands more Montanans are eligible. Stay tuned for the release of our report later this week, which will detail our research on strategies that other states have undertaken to reach eligible individuals and get them the health coverage they need.

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