Covering Low-Income Childless Adults in Medicaid: Experiences from Selected States

Stephen A. Somers and Allison Hamblin, Center for Health Care Strategies, James M. Verdier and Vivian L.H. Byrd

August 2010

Under health reform, 16-20 million beneficiaries will be eligible to enroll in Medicaid. It is critical for Medicaid stakeholders to develop a better understanding of who these beneficiaries are and what their care needs are likely to be. This brief outlines key health reform provisions related to Medicaid expansion and examines existing state programs for low-income childless adults in search of potential insights on the new expansion population. Among the findings suggested by this analysis are: The expansion population will include many relatively healthy beneficiaries as well as a significant number of individuals with multiple comorbidities and high levels of likely service utilization. Individuals who are below 50 percent of the federal poverty level will have the highest levels of morbidity, including high rates of mental illness and substance abuse. Different participation rates among population subsets will drive Medicaid costs; those with more complex needs are likely to enroll first. Costs for the expansion population on average are likely to be greater than costs for parents currently enrolled in Medicaid, but less than costs for adults with disabilities. States will need partners with experience caring for people with multiple chronic conditions. Medicaid must work closely with health insurance exchanges to ensure continuity of care for beneficiaries crossing income thresholds.

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