4 Ways Kentucky, Arkansas Successfully Implemented Medicaid Expansion

States that have chosen to expand Medicaid under the Affordable Care Act, have the ability to do so either through the traditional expansion envisioned by the law or by an alternate coverage expansion through waivers with the federal government.

A new analysis by UnitedHealth Group has focused on the 2 states that have been most successful in each of these paths: Kentucky and Arkansas.

Through traditional expansion, Kentucky increased Medicaid enrollment by 76% in the first year of expansion, which led to the overall uninsured rate to decline from 20.6% in 2013 to 9.9% in 2014. Arkansas increased its own Medicaid enrollment by 46% through waivers, which led to the overall uninsured rate to decline from 24.1% to 12.2%.

Using the tradition expansion model, Kentucky expanded coverage to individuals with household incomes up to 138% of the federal poverty line. Plans that these enrollees were qualified for had no premiums and limited cost-sharing requirements. In addition to the Medicaid expansion, Kentucky implemented a state-based public exchange.

Arkansas took a slightly different route. The state was granted permission to expand coverage for parents between 17% and 138% of the federal poverty line and for childless adults up to 138% of the federal poverty line. Coverage was provided through health plans on the Arkansas Public Exchange, which is implemented jointly by the state and the federal government. These individuals also do not pay premiums and their cost-sharing is equal to that of state residents enrolled in Medicaid.

There is more to successfully increasing coverage of low-income residents than simply expanding Medicaid coverage. Although these 2 states went about the expansion in different ways, there were several strategies in both states that led to their success:

• Integrating administration and enrollment
• Establishing multiple application pathways
• Providing robust consumer assistance
• Developing high-impact awareness campaigns

According to the findings from UnitedHealth Group, effectively using these 4 strategies could mean covering as many as 1 in 3 adults who remain uninsured. In 2014, there was an estimated 8 million adults who were eligible for Medicaid, but who had not enrolled for coverage.

“Learning from the experiences in Kentucky and Arkansas can help pave the way for sustained increases in coverage nationwide,” Lambert van der Walde, executive director of the UnitedHealth Center for Health Reform & Modernization, said in a statement.