Association Between Marketplace Policy and Public Coverage Among Medicaid or Children’s Health Insurance Program–Eligible Children and Parents

摘要

Increases in health insurance coverage after 2013 varied by state-level policy choices under the Affordable Care Act (ACA).1,2 Larger increases were observed in states adopting the Medicaid expansion to adults,1,2 and Medicaid enrollment grew more in states using state-based marketplaces.2 Another policy dimension on which states differed was marketplace authority to enroll publicly eligible applicants in Medicaid or the Children’s Health Insurance Program (CHIP). The ACA’s “no wrong door” policy requires all marketplaces to assess whether applicants are eligible for Medicaid/CHIP, but only requires state-based marketplaces to enroll publicly eligible applicants. States relying on federally facilitated marketplaces (including those with state-federal partnership or federal information technology support) can opt to defer final enrollment authority to state-level Medicaid/CHIP agencies.3 Take-up of public coverage in these states could be dampened if Medicaid/CHIP-eligible applicants face process delays, process errors, or reversals in applicants’ assessed eligibility. We consider the role of marketplace policy in early years of the adult Medicaid expansion, comparing changes in the probability that Medicaid/CHIP-eligible children and parents living in expansion states enrolled in public coverage across marketplace structure and enrollment authority.