Oct. 16—An emerging trend among the few marketplace enrollment data federal and state officials have released is that most new sign-ups have joined Medicaid plans—instead of private insurance plans.

The 36 federally operated insurance marketplaces, or exchanges, and most state-run versions created by the Affordable Care Act (ACA) have declined to say how many people have signed up for coverage since enrollment began Oct. 1. But in the two states that have detailed their enrollments, more applicants have signed up for coverage from Medicaid than from private insurers.

Enrollment eligibility in either Medicaid or for private insurance is based on income and determined after applicants submit their individual and family incomes.

In Washington state, 21,865 people, or 88 percent of the 24,949 applicants who completed enrollments by Oct. 14, were added to the state’s Medicaid program, according to the marketplace. Among those, 8,495 were found already eligible for Medicaid before consideration of the federal law’s expansion of Medicaid eligibility to all residents with incomes of up to 138 percent of the federal poverty level. 

Connecticut’s health insurance marketplace reported Oct. 11 that 1,544 applicants were put in the Medicaid program and 1,443 gained private insurance. 

The exchanges are frequently portrayed in the media as the means for the ACA to enroll an estimated 7 million people in private insurance coverage for 2014. But the marketplaces are also designed as the primary tool for funneling 8 million new beneficiaries into state Medicaid programs next year.

The state and federal marketplaces have been plagued by widespread technological failures since enrollment began, which has sharply limited the ability of applicants to enroll in coverage. National estimates have concluded as few as 47,000 applicants have enrolled within the first two weeks.

The high share of Medicaid beneficiaries among enrollments have left a smaller share of enrollees to join private insurance plans, potentially adding to the commercial insurers’ challenges in gaining enough enrollments to maintain solvency. 

The larger-than-expected share of enrollees with Medicaid coverage also could have an impact on hospitals, which are generally paid at higher rates by private insurance plans than by state Medicaid programs.

Publication Date: Wednesday, October 16, 2013