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Texas Sees Rise in Medicaid Signups

More than 80,000 additional Texans have enrolled in Medicaid or the Children’s Health Insurance Program since the rollout of the Affordable Care Act last fall, despite Republican state leaders’ decision not to expand eligibility.

Yesenia Alvarado holds her daughter, Medicaid patient Melanie Almaraz, 2, while waiting to see Dr. Alberto Vasquez for the treatment of a fever at Su Clinica Familiar in Harlingen on Jul. 9, 2013.

More than 80,000 additional Texans have enrolled in Medicaid or the Children’s Health Insurance Program since the rollout of the Affordable Care Act last fall despite Republican state leaders’ decision not to expand eligibility to poor adults, according to federal figures. 

The 80,435 new enrollees as of May — mostly Texans who already qualified for coverage but did not previously seek it — represent a 1.8 percent increase over pre-Obamacare figures. That places Texas, which has the nation’s highest uninsured rate, in the middle of the pack among states that chose not to expand access to those programs to everyone under 138 percent of the federal poverty line under the president's signature health law. The expansion, a key tenet of Obamacare, was deemed optional by the U.S. Supreme Court.

This "woodwork effect" or "welcome mat effect" — in which people hear about Medicaid expansions around the country and learn they qualify in Texas — has not been huge. Roughly 874,000 Texans eligible for Medicaid or CHIP have still not enrolled, according to Kaiser Family Foundation estimates. That includes more than 700,000 children, said Christine Sinatra, state communications director for Enroll America, a group seeking to get the uninsured covered under the federal health law.

Stephanie Goodman, spokeswoman for the Texas Health and Human Services Commission, said her agency started seeing enrollment rates rise a couple of years ago, when the conversation on Obamacare was heating up. After the act took effect, and parents took to the federal marketplace to purchase private insurance plans, many discovered that their children were eligible for Medicaid, Goodman added.

Among states that did expand Medicaid, Oregon saw the highest increase, at 51.9 percent.

But Monday’s announcement, based on data the U.S. Centers for Medicare and Medicaid Services released last week, shows that participation in Medicaid and CHIP is rising nonetheless in nearly all states.

Though experts caution that there's no definitive cause, they say the rollout of the act and the national conversation around it have raised awareness and informed many people that they were already eligible.

Get Covered America and Enroll America, which are leading the charge to bring more people into the coverage fold across the country, also cited the Affordable Care Act’s simplification of the sign-up process as a driver of Texas’ recent enrollment growth, which took off in the spring.

And though Texas leaders did not expand Medicaid, the criteria for eligibility here and elsewhere did broaden slightly: The act raised from 21 to 26 the age at which people formerly in the foster care system have to give up their Medicaid coverage.

Absent the Medicaid expansion that Texas chose not to join, Medicaid and CHIP eligibility in the state is generally limited to members of several vulnerable groups, including children under 200 percent of the federal poverty line and some low-income seniors, pregnant women and parents, Sinatra said.

734,000 Texans have signed up for private health insurance plans via the federal marketplace since the Affordable Care Act’s rollout.

Dallas was one of eight cities nationwide awarded grants last week by the National League of Cities to augment Medicaid and CHIP enrollment efforts.

Sinatra said organizers have learned that in-person assistance with navigating the system and high levels of follow-up are critical to boosting enrollment numbers, especially among communities of color.

Though the open enrollment period for the marketplace is over, Medicaid and CHIP enrollment is open year-round. Enroll America plans to continue outreach efforts to try to raise the numbers further, beginning with a convention on Wednesday in Austin to discuss best practices for recruiting enrollees. “There are a lot of people who have had an experience of feeling like they’re shut out,” Sinatra said. “We acknowledge there’s more work to be done.”

This story was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente. 

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