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Shifting Medicaid enrollees into exchanges could improve access to care

Robert Wood Johnson Foundation analyzed six states' approach to expanding Medicaid

As several states have implemented their own version of Medicaid expansion, shifting Medicaid enrollees into health insurance exchange plans can boost consumers' access to healthcare and stimulate the marketplaces, according to a new report from the Urban Institute and the Robert Wood Johnson Foundation.

Researchers analyzed how six states--Arkansas, Indiana, Iowa, Michigan, New Hampshire and Pennsylvania--chose to expand health coverage, and found that enrolling Medicaid beneficiaries in exchanges could increase marketplace competition and lower overall premiums.

The problem, though, is that exchange plans are usually more expensive than Medicaid plans. Plus, consumers might not have access to wrap-around benefits required under Medicaid because they're not always offered in exchange plans.

The report also found that creating health savings accounts for Medicaid enrollees, like Indiana has done, is cost-prohibitive and challenging to design behavior incentives to improve health outcomes for this consumer group.

"The administrative costs of maintaining tens of thousands of individual accounts with very small monthly contributions from enrollees are likely to be significantly higher than the benefits, including any changes in utilization of services that might result," the authors wrote.

Additionally, the report noted that more research is needed to evaluate whether wellness programs are a cost effective strategy for Medicaid expansion. For example, Iowa offers incentives to its Medicaid beneficiaries to help them make healthier decisions and, in turn, save the program money, FierceHealthPayer previously reported.

Overall, the researchers found that in order to determine which alternative Medicaid expansion approaches are most successful, states must make their implementation process transparent.

To learn more:
- here's the RWJF report

Related Articles:
New Hampshire becomes latest state to expand Medicaid
States struggle to entice Medicaid enrollees to participate in incentive programs
Iowa Medicaid privatization plan pits savings against services
Indiana latest state to expand Medicaid