Benefit Design for Newly Eligible Adults in Medicaid Expansion States

A review of the benefit design choices made by states that expanded Medicaid (as of the end of 2014), revealed that states are offering more generous coverage that what is required under federal law, according to researchers with The Commonwealth Fund.

For states that chose to expand Medicaid coverage to adults between the ages of 19 and 64 years with incomes at or below 138% of the federal poverty line, the Affordable Care Act allowed flexibility to decide the level of coverage provided to these adults. States could follow the same essential health benefit standard applicable to health plans sold in the health insurance marketplace, which would be the minimum standard, or they could offer a higher level of coverage.

The researchers sought to determine if states viewed newly eligible adults as different from traditional beneficiaries in their health and healthcare needs. What they found was that with the generous coverage states chose to offer, they either narrowed or eliminated the distinction between coverage levels for newly eligible adults and traditional beneficiaries.

“This suggests that states view the newly eligible beneficiaries as having the elevated health and health care needs that are common among low-income populations,” the authors wrote.

All 27 states, plus the District of Columbia, that chose to expand Medicaid chose to bring their benchmark coverage up to the levels offered under their traditional Medicaid plans, the investigators found. In addition, most states also supplemented their coverage with long-term care, vision and oral healthcare, and hearing aids. Nearly all states chose to offer generous prescription drug coverage.

Although newly eligible Medicaid adults may be in better health than the traditional Medicaid population, these newly eligible beneficiaries likely includes a high proportion of previously uninsured adults with serious physical and mental health conditions that had gone untreated while they were uninsured, explained the researchers.

“… it makes sense that states expanding Medicaid would design coverage for newly eligible adults much as they have done for traditional beneficiaries,” the authors concluded.