Expanding health coverage through marketplace facilitated enrollment programs
- Collection:
- Health Policy and Services Research
- Author(s):
- Levitis, Jason, author O'Brien, Claire, (Of Urban Institute), author
- Contributor(s):
- Health Policy Center (Urban Institute), issuing body. Commonwealth Fund, issuing body.
- Publication:
- Washington, DC : Urban Institute, December 2023
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Health Equity -- economics Health Insurance Exchanges Health Policy Insurance Coverage Medicaid State Health Plans United States
- Genre(s):
- Technical Report
- Abstract:
- A well-known challenge in expanding health coverage is getting eligible people to enroll - more than half of the uninsured are eligible for subsidized coverage. Efforts to increase take-up have often focused on carrots like generous subsidies, sticks like individual mandate penalties, and outreach to increase awareness of coverage options. But recently, a new set of tools - collectively called facilitated enrollment programs - has gained prominence, especially at the state level. These interventions focus on leveraging existing interactions with the consumer to simplify, encourage, or automate enrollment, often with the help of behavioral nudges or innovative technology. These approaches may be especially attractive to states since they are relatively inexpensive and increase enrollment in programs that the federal government primarily subsidizes. They also address a growing awareness that administrative burdens - the informational, compliance, and psychological costs of navigating administrative processes - impede access to government benefits, especially for people of color and other historically disadvantaged groups. The past few years have seen a burst of new facilitated enrollment programs tied to state-based Marketplaces (SBMs). Since Maryland established its “easy enrollment” program in 2019, 18 other states - including virtually every state with an SBM - have adopted some form of facilitated enrollment. There are three key design questions for any facilitated enrollment program: the existing interaction that serves as the source of information and engagement, the specific information collected and how that information is used to advance enrollment. Other potential design issues include the provision of a special enrollment period (SEP), coordination with a state subsidy, and a plan selection algorithm. Currently, there are two predominant models. The first uses state income tax filing - a key moment of consumer engagement with the state - to ask about any uninsured family members and for permission to share information with the Marketplace, which then uses it for outreach and, in some cases, other purposes, like estimating eligibility. The second model seeks to ease transitions to Marketplace coverage for consumers exiting Medicaid, which is particularly relevant during the unwinding of the Medicaid continuous coverage requirement. This approach typically goes further down the path to enrollment, with measures like projecting eligibility for Marketplace subsidies, choosing a plan, or even effectuating enrollment. This paper focuses primarily on programs run by SBMs, which can lead to either Marketplace or Medicaid/CHIP coverage. Many of the same techniques could be employed by Medicaid agencies or the federal Marketplace. A key outstanding question is how effectively these programs can drive coverage growth. The more advanced versions are so nascent that there is little evidence of their impact. But they are clearly a less expensive means of expanding coverage than other options like state-supported subsidies. Thus, experimentation is likely to continue.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-DC license. (More information)
- Extent:
- 1 online resource (1 PDF file (24 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918750488406676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918750488406676