New Report Examines Successful Medicaid Enrollment Strategies

A new Brief from UnitedHealth Group’s (NYSE: UNH) Center for Health Reform & Modernization identifies proven strategies states have adopted to efficiently and effectively enroll Medicaid-eligible individuals and families. “Successful Medicaid Enrollment Strategies to Cover the Uninsured,” focuses on common strategic approaches Kentucky and Arkansas adopted to enroll their uninsured residents.

The Brief identifies four strategic approaches focused on ensuring that individuals who qualify for coverage are aware of their eligibility and can gain and keep coverage. The key to achieving robust increases in coverage is not adopting a set of uniform policy prescriptions, but addressing priorities that apply broadly to all states.

Integrating Administration and Enrollment. Leveraging information sharing and data-verification tools to confirm consumers’ eligibility, deliver consumer-friendly application experiences, and avoid unnecessary delays in providing coverage.
Establishing Multiple Application Pathways. Allowing consumers to enroll in person, online, by phone, or through the mail and to experience a simple, standard enrollment process regardless of how and where they initiate their application.
Providing Robust Consumer Assistance. Using state-wide outreach and targeted strategies to reach specific communities, such as residents in isolated rural areas and non-English speakers, and ensuring credentialed assisters can help consumers initiate and complete their applications.
Developing High-Impact Awareness Campaigns. Delivering clear messages through multiple channels to reach potential applicants, encouraging enrollment, and leveraging relationships with community-based organizations and other partners to amplify the impact.

In Kentucky, Medicaid enrollment increased by 76 percent in 2014, which was the largest increase of any state. Arkansas saw a 46 percent increase in enrollment, the largest increase any state implementing an alternate coverage expansion in 2014.

Thanks in large part to these increases in enrollment, each state effectively cut in half its uninsured rate for adults aged 18 to 64, the Brief found. Kentucky’s uninsured rate declined from 20.6 percent to 9.9 percent between 2013 and 2014. Arkansas’ uninsured rate declined from 24.1 percent to 12.2 percent.

The success of Kentucky and Arkansas was part of a national reduction in the uninsured: between 2013 and 2014 the number of adults without coverage fell by eight million individuals, driven largely by an increase in Medicaid enrollment. There remains substantial opportunity to increase coverage as approximately 30 million people in the U.S. remain uninsured. Medicaid has the potential to cover an additional 12 million uninsured adults, about one out of every three who did not have coverage in 2014, including eight million who already are eligible for coverage but not enrolled.

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

In some states, relatively smaller increases in enrollment and reductions in the uninsured rate during the Brief’s study period reflect earlier efforts to cover low-income populations. These states began the study period with fewer uninsured residents.

To read the full brief and find more analysis prepared by the Center for Health Reform & Modernization, go to: www.unitedhealthgroup.com/modernization.

About the UnitedHealth Center for Health Reform & Modernization
Drawing on UnitedHealth Group’s internal expertise and data, and its external experiences and partnerships, the UnitedHealth Center for Health Reform & Modernization analyzes key health care issues and develops innovative policies and practical solutions for the health care challenges facing our nation. We share this information in the United States and internationally with policymakers, academics, researchers, providers, health plans, employers, the public, and other key health care stakeholders. UnitedHealth Group launched the Center for Health Reform & Modernization to present proven strategies to contain costs and improve quality and care and we continue to demonstrate our commitment to health care modernization by offering solutions based on proven policies and best practices.

State-by-State Comparison

Alabama	Did not implement an expansion of eligibility for low income residents during the Brief's study period, saw an 8.5 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in Alabama declined from 20.1 percent to 16.5 percent, a reduction of 18.1 percent.
Alaska	Did not implement an expansion of eligibility for low income residents during the Brief's study period, saw a 4.3 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in Alaska declined from 23.8 percent to 20.3 percent, a reduction of 14.8 percent.
Arizona	Implemented an expansion of eligibility for low income residents during the Brief's study period, saw a 25.3 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in Arizona declined from 23.5 percent to 20.2 percent, a reduction of 14.2 percent.
Arkansas	Implemented an expansion of eligibility for low income residents during the Brief's study period, saw a 45.6 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in Arkansas declined from 24.1 percent to 12.2 percent, a reduction of 49.3 percent.
California	Implemented an expansion of eligibility for low income residents during the Brief's study period, saw a 23.4 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in California declined from 24.0 percent to 17.0 percent, a reduction of 29.2 percent.
Colorado	Implemented an expansion of eligibility for low income residents during the Brief's study period, saw a 44.8 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in Colorado declined from 18.8 percent to 12.4 percent, a reduction of 34.1 percent.
Connecticut	Implemented an expansion of eligibility for low income residents during the Brief's study period. Between 2013 and 2014, the uninsured rate in Connecticut declined from 13.2 percent to 6.4 percent, a reduction of 51.2 percent. Data was unavailable to measure the change in Medicaid enrollment during the period of study.
Delaware	Implemented an expansion of eligibility for low income residents during the Brief's study period, saw a 3.1 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in Delaware declined from 12.9 percent to 11.8 percent, a reduction of 8.6 percent.
District of Columbia	Implemented an expansion of eligibility for low income residents during the Brief's study period, saw a 7.8 percent increase in Medicaid enrollment between 2013 and 2014. Data was unavailable to measure the uninsured rate during the period of study.
Florida	Did not implement an expansion of eligibility for low income residents during the Brief's study period, saw an 8.8 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in Florida declined from 28.8 percent to 23.8 percent, a reduction of 17.2 percent.
Georgia	Did not implement an expansion of eligibility for low income residents during the Brief's study period, saw a 12.9 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in Georgia declined from 25.9 percent to 23.1 percent, a reduction of 10.7 percent.
Hawaii	Implemented an expansion of eligibility for low income residents during the Brief's study period, saw a 1.9 percent decline in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in Hawaii declined from 9.6 percent to 8.1 percent, a reduction of 15.5 percent.
Idaho	Did not implement an expansion of eligibility for low income residents during the Brief's study period, saw an 11.6 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in Idaho declined from 23.0 percent to 17.5 percent, a reduction of 23.6 percent.
Illinois	Implemented an expansion of eligibility for low income residents during the Brief's study period, saw a 15.9 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in Illinois declined from 18.4 percent to 13.0 percent, a reduction of 29.0 percent.
Indiana	Did not implement an expansion of eligibility for low income residents during the Brief's study period, saw a 6.7 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in Indiana declined from 19.2 percent to 17.0 percent, a reduction of 11.1 percent.
Iowa	Implemented an expansion of eligibility for low income residents during the Brief's study period, saw a 15.2 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in Iowa declined from 11.6 percent to 9.9 percent, a reduction of 14.4 percent.
Kansas	Did not implement an expansion of eligibility for low income residents during the Brief's study period, saw a 6.0 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in Kansas increased from 17.5 percent to 20.1 percent, an increase of 15.2 percent.
Kentucky	Implemented an expansion of eligibility for low income residents during the Brief's study period, saw a 76.4 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in Kentucky declined from 20.6 percent to 9.9 percent, a reduction of 52.0 percent.
Louisiana	Did not implement an expansion of eligibility for low income residents during the Brief's study period, saw a 3.0 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in Louisiana declined from 24.2 percent to 19.1 percent, a reduction of 20.7 percent.
Maine	Did not implement an expansion of eligibility for low income residents during the Brief's study period. Between 2013 and 2014, the uninsured rate in Maine declined from 15.9 percent to 11.5 percent, a reduction of 28.0 percent. Data was unavailable to measure the change in Medicaid enrollment during the period of study.
Maryland	Implemented an expansion of eligibility for low income residents during the Brief's study period, saw a 33.5 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in Maryland declined from 14.1 percent to 8.5 percent, a reduction of 39.5 percent.
Massachusetts	Implemented an expansion of eligibility for low income residents during the Brief's study period, saw a 14.2 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in Massachusetts declined from 5.2 percent to 4.9 percent, a reduction of 6.1 percent.
Michigan	Implemented an expansion of eligibility for low income residents during the Brief's study period, saw a 12.8 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in Michigan declined from 16.0 percent to 13.8 percent, a reduction of 13.6 percent.
Minnesota	Implemented an expansion of eligibility for low income residents during the Brief's study period, saw a 27.0 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in Minnesota declined from 10.9 percent to 8.5 percent, a reduction of 22.1 percent.
Mississippi	Did not implement an expansion of eligibility for low income residents during the Brief's study period, saw an 8.8 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in Mississippi declined from 24.7 percent to 20.6 percent, a reduction of 16.5 percent.
Missouri	Did not implement an expansion of eligibility for low income residents during the Brief's study period, saw a 2.2 percent decline in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in Missouri declined from 18.3 percent to 16.1 percent, a reduction of 11.8 percent.
Montana	Did not implement an expansion of eligibility for low income residents during the Brief's study period, saw an 8.5 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in Montana declined from 23.0 percent to 17.5 percent, a reduction of 23.7 percent.
Nebraska	Did not implement an expansion of eligibility for low income residents during the Brief's study period, saw a 3.3 percent decline in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in Nebraska declined from 16.1 percent to 14.2 percent, a reduction of 11.7 percent.
Nevada	Implemented an expansion of eligibility for low income residents during the Brief's study period, saw a 65.7 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in Nevada declined from 27.0 percent to 21.2 percent, a reduction of 21.5 percent.
New Hampshire	Implemented an expansion of eligibility for low income residents during the Brief's study period, saw a 21.9 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in New Hampshire declined from 15.4 percent to 14.3 percent, a reduction of 7.2 percent.
New Jersey	Implemented an expansion of eligibility for low income residents during the Brief's study period, saw a 26.1 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in New Jersey declined from 18.6 percent to 14.6 percent, a reduction of 21.5 percent.
New Mexico	Implemented an expansion of eligibility for low income residents during the Brief's study period, saw a 29.8 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in New Mexico declined from 26.9 percent to 20.4 percent, a reduction of 24.3 percent.
New York	Implemented an expansion of eligibility for low income residents during the Brief's study period, saw a 9.6 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in New York declined from 15.0 percent to 12.1 percent, a reduction of 19.8 percent.
North Carolina	Did not implement an expansion of eligibility for low income residents during the Brief's study period, saw a 6.9 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in North Carolina declined from 22.6 percent to 17.8 percent, a reduction of 21.1 percent.
North Dakota	Implemented an expansion of eligibility for low income residents during the Brief's study period, saw a 15.5 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in North Dakota declined from 13.4 percent to 12.6 percent, a reduction of 6.0 percent.
Ohio	Implemented an expansion of eligibility for low income residents during the Brief's study period, saw an 18.8 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in Ohio declined from 15.7 percent to 11.8 percent, a reduction of 24.5 percent.
Oklahoma	Did not implement an expansion of eligibility for low income residents during the Brief's study period, saw a 2.3 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in Oklahoma declined from 24.7 percent to 21.4 percent, a reduction of 13.6 percent.
Oregon	Implemented an expansion of eligibility for low income residents during the Brief's study period, saw a 62.0 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in Oregon declined from 21.2 percent to 12.8 percent, a reduction of 39.7 percent.
Pennsylvania	Did not implement an expansion of eligibility for low income residents during the Brief's study period, saw a 1.3 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in Pennsylvania declined from 13.5 percent to 12.7 percent, a reduction of 6.4 percent.
Rhode Island	Implemented an expansion of eligibility for low income residents during the Brief's study period, saw a 35.2 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in Rhode Island declined from 16.2 percent to 11.5 percent, a reduction of 29.3 percent.
South Carolina	Did not implement an expansion of eligibility for low income residents during the Brief's study period, saw an 11.6 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in South Carolina declined from 22.9 percent to 18.8 percent, a reduction of 17.6 percent.
South Dakota	Did not implement an expansion of eligibility for low income residents during the Brief's study period, saw a 0.4 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in South Dakota declined from 15.9 percent to 14.4 percent, a reduction of 9.3 percent.
Tennessee	Did not implement an expansion of eligibility for low income residents during the Brief's study period, saw a 10.3 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in Tennessee declined from 20.0 percent to 18.0 percent, a reduction of 10.1 percent.
Texas	Did not implement an expansion of eligibility for low income residents during the Brief's study period, saw a 4.5 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in Texas declined from 29.9 percent to 27.0 percent, a reduction of 9.6 percent.
Utah	Did not implement an expansion of eligibility for low income residents during the Brief's study period, saw a 3.0 percent decline in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in Utah declined from 18.5 percent to 15.8 percent, a reduction of 14.7 percent.
Vermont	Implemented an expansion of eligibility for low income residents during the Brief's study period, saw a 42.3 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in Vermont declined from 10.2 percent to 8.5 percent, a reduction of 16.9 percent.
Virginia	Did not implement an expansion of eligibility for low income residents during the Brief's study period, saw a 0.9 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in Virginia declined from 17.2 percent to 16.8 percent, a reduction of 2.3 percent.
Washington	Implemented an expansion of eligibility for low income residents during the Brief's study period, saw a 39.8 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in Washington declined from 19.8 percent to 11.9 percent, a reduction of 39.9 percent.
West Virginia	Implemented an expansion of eligibility for low income residents during the Brief's study period, saw a 49.2 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in West Virginia declined from 20.7 percent to 12.8 percent, a reduction of 38.1 percent.
Wisconsin	Did not implement an expansion of eligibility for low income residents during the Brief's study period, saw a 2.2 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in Wisconsin declined from 12.8 percent to 9.2 percent, a reduction of 28.2 percent.
Wyoming	Did not implement an expansion of eligibility for low income residents during the Brief's study period, saw a 4.8 percent increase in Medicaid enrollment between 2013 and 2014. During this period, the uninsured rate in Wyoming declined from 19.2 percent to 14.3 percent, a reduction of 25.3 percent.