Aug. 7—Medicaid would expand by 18 million enrollees if all states eventually opt to grow their programs, according to recent projections—and that growth would bring new challenges for many hospitals. 

Enrollment projections reported by the Urban Institute July 31 are slightly higher than earlier estimates that Medicaid programs would gain 17 million new enrollees under the Affordable Care Act. The March 2012 projections by the Congressional Budget Office (CBO) came before the Supreme Court eliminated penalties for states that do not expand their programs. Subsequent CBO projections dropped the expected number of new Medicaid and CHIP enrollees to 13 million. 

Currently, 23 states are expanding eligibility to their Medicaid programs up to 138 percent of the federal poverty level, 21 states are not expanding, and six states continue to debate expansion, according to the Kaiser Family Foundation.

The Urban Institute report’s estimates also included people who were already eligible, but who were unenrolled and are expected to join their Medicaid program during the expansion years.

The report highlighted the wide variation in enrollment increases both between states and within states. Such variations may have large impacts on both Medicaid beneficiaries and certain providers, the report noted. For example, the influx of new enrollees will require state officials to carefully assess whether Medicaid provider networks are sufficient to meet the needs of the new populations.

“Most of those gaining Medicaid are expected to be adults, whose service needs likely differ substantially from those of the children who currently predominate in many state Medicaid programs,” wrote the authors.

Variations in language skills among new enrollees may raise new linguistic challenges for healthcare providers in some areas, given the negative impacts that language barriers can have on access to and delivery of care.

Other challenges for providers treating new Medicaid enrollees include the high rates of untreated health conditions among the new patients, 73 percent of whom were previously uninsured. 

Due to the range of uncertainties, the report’s authors called for Medicaid officials to carefully track whether the supply of providers keeps up with demands for care from new enrollees.

Publication Date: Wednesday, August 07, 2013