Medicaid and Marketplace Outreach and Enrollment Options for States

Kristine Goodwin and Laura Tobler 5/13/2014


Group of people photoThe Affordable Care Act (ACA) is expected to cover millions of newly insured Americans through Medicaid expansion and new health insurance marketplaces. During the marketplace’s first open enrollment period, which began Sept. 1, 2013 and ended March 31, 2014, the federal Department of Health and Human Services (HHS) estimated that 8 million Americans obtainedcoverage through the marketplaces. These marketplace enrollment numbers will change as people who qualified for an extension gain coverage and are added to the rolls and those that signed up for coverage but failed to provide payment are dropped. HHS also reports that an additional 4.8 million people enrolled in Medicaid from September 2013 to February 2014—about 4.2 million of these enrollees live in states that opted for the Medicaid expansion. The next open enrollment period begins on Nov. 15, 2014.

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The Congressional Budget Office (CBO) estimated that six million Americans would enroll in private health insurance plans through the marketplaces and eight million people would enroll in Medicaid and the Children’s Health Insurance Program (CHIP) in 2014. By 2017, the CBO predicts that 24 million people will enroll in private health insurance plans through the marketplaces and another 12 million in Medicaid and CHIP. An individual mandate with penalties for not obtaining insurance and new coverage options are intended to extend coverage to unprecedented numbers of Americans.

Yet, we know from prior Medicaid expansions and early experiences with the federal law that reaching and enrolling newly eligible individuals can be a challenge. Attracting young, healthy people, improving consumer understanding about new rules and coverage options, and bolstering enrollment when there are relatively small penalties for non-participation are just some of the factors that hamper efforts to enroll people in coverage. To address these challenges, the federal government and many states are adopting a wide assortment of strategies to facilitate enrollment and minimize barriers that have hindered previous coverage efforts.

This brief discusses outreach and enrollment requirements under the ACA and highlights common challenges, and promising outreach and enrollment strategies and options. It is intended to help legislators identify potential roles and opportunities to ensure that federal and state investments are helping states achieve objectives.

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