It’s been nearly two years since Colorado started collecting a fee from hospitals in order to expand access to Medicaid and CHP+. In addition to the revenue generated by that program, Colorado has qualified for federal grants totaling almost $40 million over the past couple years ($13.7 million at the end of 2010, and $26.1 million at the end of 2011). The grant money was awarded based on increased enrollment in Medicaid and CHP+ and the improvements Colorado has made to the application/retention process for those programs. In short, Colorado has worked hard to expand access to health insurance for low income residents. Combined with the recession, that has resulted in a record high number of people enrolled in Colorado Medicaid and CHP+.
One of the goals for Medicaid expansion back when the hospital provider fee was enacted was that the state would be able to expand Medicaid eligibility to adults without children. People generally think of Medicaid as providing health insurance to anyone with a low income, but in reality the Colorado program has rules limiting eligibility to families with children, children, pregnant women, people with disabilities, and elderly people with few assets who are in need of long term care (remember, Medicare provides health insurance for seniors, but doesn’t cover long term care).
The recession and influx of people that it pushed onto the Medicaid rolls caused the program to scale back their projections for covering adults without children. But applications for that coverage will be accepted starting this week until the middle of May. At that point, the state will randomly select 10,000 of the applications and those people will be enrolled in the adult Medicaid program.
Unfortunately, the eligibility guidelines will eliminate all but the very lowest income people. In order to qualify, an applicant has to have an income of no more than 10% of the Federal Poverty Level – that amounts to $90 a month for a single person or $125/month for a married couple. As low as those numbers are, officials estimate that there are 50,000 adults in Colorado who would qualify based on those income requirements. And the Medicaid program only has room to enroll 10,000 of them – hence the lottery system.
I have to wonder what percentage of those 50,000 people will submit applications though? Back when the ACA created high risk pool health insurance programs in every state, they predicted that up to 375,000 people might enroll in 2010 alone. But as of early 2012, the high risk pools had actually enrolled about 50,000 people. Obviously cost is an issue – the high risk pools have significant premiums that may be out of reach for a lot of uninsured people, and that shouldn’t be a factor for the Medicaid expansion program. But there’s still the problem of getting information out to the people who might qualify, and getting them to submit applications – especially if they know that submitting an application is no guarantee of coverage, since the program is going to use a lottery to select 10,000 people to enroll.
Even though the income requirements are extremely low and the program only has the means to insure 20% of the eligible population, this is another step that Colorado is taking to try to insure more people. We’re slowing making progress there, due largely to the state’s efforts to expand access to public health insurance programs. We have a long way to go (currently ranked 24th out of 50 states for the percentage of our population that’s uninsured) but small changes like this one are better than no change at all.