Academy health deleire_june_2010


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Presentation by Tom DeLeire at AcademyHealth 2010 ARM

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  • Retention of autoenrollees qualitatively equal to retention of enrollees entering through more traditional means –IF– they aren’t subject to premium requirements
  • 1. Use the American Community Survey to aid in a thought experiment: would this be a good strategy to target low-income parents? 2. Varies across states, so we calculate state-by-state tallies of the number of low-income parents potentially captured via autoenrollment and what percent of these autoenrollees are uninsured vs. having private coverage 133% FPL (about $24,000 for a family of 3 in the contiguous US)
  • Academy health deleire_june_2010

    1. 1. Getting Parents Enrolled in Medicaid: Lessons from Wisconsin‘s BadgerCare Plus Auto-Enrollment Process Thomas DeLeire Lindsey Leininger, Laura Dague, Shannon Mok, Donna Friedsam University of Wisconsin-Madison
    2. 2. Health Care Reform <ul><li>A key coverage component of the law is an expansion of Medicaid to 133% FPL </li></ul><ul><ul><li>CBO estimates that roughly 50% of the increase in coverage will come from Medicaid expansion </li></ul></ul><ul><li>Low-income parents represent an appreciable portion of the newly eligible population </li></ul><ul><ul><li>4.1 million or 34% of newly eligible adults </li></ul></ul>
    3. 3. Enrollment of Eligible Persons <ul><li>Many eligible individuals do not enroll in Medicaid </li></ul><ul><ul><li>75% of uninsured children and 28% of uninsured parents are eligible for public insurance (Holahan et al., 2007) </li></ul></ul><ul><li>Getting uninsured individuals enrolled quickly may be important for improving health (McWilliams et al., 2009) </li></ul>
    4. 4. Auto-Enrollment Should be Considered for Health Reform Implementation <ul><li>Outline </li></ul><ul><ul><li>Wisconsin’s experience with auto-enrollment </li></ul></ul><ul><ul><li>National and state by state estimates of the number of parents that could be auto-enrolled </li></ul></ul>
    5. 5. The Launch of <ul><li>WI’s BadgerCare+ : joint Medicaid & CHIP program </li></ul><ul><li>Massive reform effort launched in Feb. 2008 </li></ul><ul><ul><li>Eligibility expansion </li></ul></ul><ul><ul><li>Auto-enrollment </li></ul></ul><ul><ul><li>Simplification of enrollment and recertification processes </li></ul></ul><ul><ul><li>Aggressive marketing campaign </li></ul></ul>
    6. 6. Auto-Enrollment in Wisconsin <ul><li>WI implemented a one-time “auto-conversion” effort immediately prior to BC+ program launch </li></ul><ul><ul><li>Auto-enrolled 44,000 previously ineligible or pending applicants </li></ul></ul><ul><ul><ul><li>Applied new program eligibility criteria to previously ineligible individuals for whom there was current administrative data </li></ul></ul></ul><ul><ul><ul><li>92% of were siblings and/or parents of existing beneficiaries </li></ul></ul></ul>
    7. 7. Auto-Enrollment in Wisconsin <ul><li>Anyone who had a family member enrolled in state health programs in December 2007 or January 2008), or who had had a case closed 30 days prior were auto-enrolled </li></ul><ul><li>44,000 auto-enrollees out of almost 70,000 individuals newly enrolled in the first month </li></ul>
    8. 8. Kaplan-Meier Estimates of Disenrollment by Auto-Enrollment
    9. 9. Auto-Converts vs. Other New February 2008 Entrants
    10. 10. Auto-Enrollment Potentially Useful In Federal Reform <ul><li>American Community Survey, 2008 </li></ul><ul><li>Calculate the number of parents who would become newly eligible under 133% FPL eligibility </li></ul><ul><li>Calculate what fraction of these have children already on public insurance </li></ul><ul><li>Calculate what fraction of these are currently uninsured </li></ul>
    11. 12. Percent of Newly Eligible Parents Who Are Potential Auto-Enrollees
    12. 13. Percent of Potential Auto-Enrollees with Private Health Insurance
    13. 14. Conclusion <ul><li>Auto-enrollment of parents </li></ul><ul><ul><li>Should be feasible given many existing data systems </li></ul></ul><ul><ul><li>Has the potential to enroll 2.3 million parents immediately upon program expansion </li></ul></ul><ul><ul><li>Is target efficient as 75% of these parents are uninsured </li></ul></ul>