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Regulation and Compliance > State Regulation

PPACA Medicaid sign-ups reveal disparities

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Just 10 states accounted for more than 80 percent of the 3 million Medicaid enrollees who’ve signed up under the Patient Protection and Affordable Care Act this year, according to fresh analysis.

Consulting firm Avalere Health analyzed government numbers, finding a wide disparity in Medicaid enrollment totals from state to state.

From October through February, California, Florida, Oregon and Washington enrolled the most new participants in the government health program for the poor, Avalere found. Florida is the only non-expansion state that’s seen new Medicaid enrollment numbers greater than 100,000, an 8.2 percent increase over summer 2013 levels.

“We continue to see dramatic variations across the states in terms of enrollment into new coverage programs,” said Jenna Stento, senior manager at Avalere Health. “While some differences may be a result of state decisions to expand Medicaid, certain non-expansion states are also seeing large increases in Medicaid enrollment.”

Though open enrollment for PPACA plans ended March 31, people can enroll in the program year-round.

The Congressional Budget Office estimated PPACA will result in 8 million new Medicaid enrollees in 2014. Last week the Centers for Medicare and Medicaid Services announced 3 million Americans enrolled in Medicaid through February 2014.

Avalare said the number could reach 3.7 million if enrollment increases at the rate of Medicaid sign-ups observed between January and February, or 4.3 million if Medicaid sign-ups follow a pattern similar to the exchanges.

“In March, enrollment in exchange plans surged dramatically as individuals signed up for coverage at more than twice the February rate of enrollment,” said Dan Mendelson, Avalere Health CEO. “Medicaid enrollment could increase at a similar rate in March, and April could see another bump as individuals assessed eligible for Medicaid by the federal exchange undergo determination by state Medicaid agencies.” 

All told, more than 61 million people — about 19 percent of the population — were enrolled in Medicaid at the end of the February, according to the Department of Health and Human Services.

Though through PPACA the administration planned to extend Medicaid nationwide, the Supreme Court ruling in 2012 made it optional for states to do so. Only 26 states and the District chose to expand Medicaid, while 19 states declined and another five are still debating.

According to the CMS report last week, enrollment in the 26 states that expanded Medicaid rose by 8.3 percent, compared with 1.6 percent in states that didn’t.

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