Medicaid enrollments higher than expected

Official says there may have been more ‘pent-up demand’ for medical care than anyone realized

bshannon@theolympian.comApril 7, 2014 

Washington health care officials always knew that a big piece of health insurance reform in the Evergreen State was an expansion of Medicaid, the federal free-care program for people with low incomes.

What they didn’t know is just how quickly the Medicaid rolls would grow. By early last week, enrollments for adults newly eligible for Medicaid as a result of the Affordable Care Act had shot past 268,000 — a milepost equal to more than a quarter of the state’s 900,000 uninsured.

As of April 1, the Medicaid enrollments include 10,047 newly eligible adults getting free care on federally subsidized Medicaid in Thurston County and another 29,356 in Pierce County.

“We had a few things work very well for us,” Nathan Johnson, director of policy, planning and performance for the Health Care Authority, said in a recent interview.

Washington is one of more than two-dozen states that, along with the District of Columbia, expanded Medicaid eligibility to cover those earning up to 138 percent of the federal poverty line, which is roughly $15,000 for a single adult or $28,000 for a family of three.

With this expansion, federal funding will cover 100 percent of the costs for newly eligible persons through 2016 and at least 90 percent through 2020.

In fact, Johnson said the agency had not expected to see even 250,000 newly eligible adults enroll until perhaps January 2018 — more than 31/2 years away.

Another 135,485 residents had signed up for Medicaid through the exchange under old eligibility rules that had stricter income limits. Altogether, more than 400,000 Washington residents are now getting coverage under Medicaid who likely did not receive it before the Washington Health Benefit Exchange opened its online portal for sign-ups Oct. 1.

The figures are likely to keep climbing throughout the year because — unlike private plan sign-ups that had a March 31 deadline — Medicaid sign-ups can happen year-round.


By contrast, sales of private insurance plans through the exchange lagged behind state targets and totaled just under 146,500 as of March 31, when open enrollment ended for purchases of private coverage in 2014. It is not yet clear how many of those customers had private insurance previously.

Johnson and others who are trying to make the Affordable Care Act work in Washington point to many factors that helped fuel the faster-than-expected Medicaid enrollments: bipartisan support in the Legislature for expanding Medicaid, a one-stop website that despite glitches made it easy for consumers to learn whether they were eligible for private insurance or Medicaid, and a good network of community groups that helped people one-on-one with applications, especially when the exchange and call centers had technological problems.

Johnson said there may have been more “pent-up demand” for medical care than anyone realized.

“What we’ve been hearing on the ground is it’s easier to sign up than people thought,” said Kayla Scrivner, community liaison officer for the Tacoma-Pierce County Health Department’s in-person assistance program that was created last year to coincide with the startup of the Washington Health Benefit Exchange.

“I think overall the main thing is the Health Care Authority set very conservative targets. I think that was smart on their part because no one knew what this would look like,’’ said Libby Weisdepp, director of operations and communications for CHOICE Regional Health Network, which oversaw outreach and in-person help efforts in Thurston and a half dozen other Western Washington counties.

“I think everyone has been pleasantly surprised at the number of individuals who have come out to get insured,’’ Weisdepp added.


Among those who did sign up is Ann Pelo, a Montesano-based author and educator who says she knows what it is like to have health coverage and then to go without it. Pelo had insurance when she worked for an early childhood education organization, and after leaving that job, she bought a bare-bones or catastrophic plan.

But insurance premiums kept climbing even for that coverage, and she let the policy go about two years ago when monthly premiums hit $280.

“It felt crummy. It felt spooky as someone who always had health (insurance) and knew what it was to have that security underneath me. I acutely felt the absence of it,’’ Pelo said.

When it came time to enroll for ACA coverage, Pelo went onto expecting to buy a private plan. She was “pleasantly startled,” as she put it, to learn that her income qualified her — as a single adult without kids — for Medicaid; her partner also qualified.

“It is night and day. That sense of … financial vulnerability is gone. And I haven’t seen a doctor in this little window I’ve been signed on,” Pelo said last week. “I haven’t had an accident. I haven’t actively used that. But I breathe easier. I definitely breathe easier.’’

Pelo said she is getting ready for a backpacking trip through the Grand Canyon and knows that “if I break my leg or fall off a cliff, it won’t wreck my financial life and the financial life of people around me.’’

Phillip and Tina Guynn of Thurston County also signed up for Medicaid. Phillip Guynn, 35, said he was struck by a car while working as a tow truck operator a decade ago, and that he had had no way to cover care for problems that were not directly caused by the accident.

Guynn said the injury left him partially paralyzed at first, which led to weight gain to nearly 500 pounds, and that led to other problems. He said he was paying about $2,000 a year for pain medications, but now has coverage for prescriptions.

“I was stuck in bed for a year and a half and got up to almost 500 pounds. I had no medical (insurance). I would go into the emergency room all the time because of the issues I was having with my weight. I was diagnosed with congestive heart failure,” Guynn said.

Eventually, hospital staff connected Guynn with Thurston County Project Access, which put him in touch with surgeons and other caregivers who helped his slow recovery along, he said. “I’m actually able to walk and stand now. I’m not back to work yet, but I’m working on getting there. I’m down to 370 pounds. It’s been a long road,” he said.

After qualifying for Medicaid this year, he started consulting with surgeons about problems in his neck and wrists that developed during his periods of immobility. Having coverage, he said, “I worry a lot less … because I’m not stressing how I’m going to be able to see a doctor and take care of problems … I’m going to see a surgeon tomorrow.’’

Brad Shannon: 360-753-1688 @bradshannon2

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