This research brief from the U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE) estimates the take-up, or estimated enrollment, of eligible individuals in the expanded Medicaid program under the Patient Protection and Affordable Care Act (ACA).  Under the ACA, the Medicaid program will be expanded to cover all individuals below 133 percent of poverty. Last Thursday, the U.S. Supreme Court upheld the constitutionality of this Medicaid expansion, as long as HHS does not withhold existing Medicaid funding from any state that declines to implement the expansion.

Factors that have been shown to impact take-up include the benefits of the program to the intended beneficiaries, information and transaction costs in enrolling, and stigma. There also are significant differences in potential assumptions that researchers have made about available data to estimate a national take-up rate.  Prior research has estimated the national take-up rate among eligible adults for Medicaid from 32% to 81%. A recent estimate of national take-up rate among eligible children for Medicaid (and the Children’s Health Insurance Program) as high as 82% to 85%.

The Congressional Budget Office (CBO) has projected that, with the implementation of the ACA, an additional 16 million people will enroll in the Medicaid program by 2019.  Recently released 2012 projections from CBO updated that figure to 17 million due to changes in economic trends and recent legislation.  While the CBO does not release details on its assumptions, two outside analyses have assessed that a Medicaid take-up rate of between 55% and 57% of newly-eligible uninsured adults could produce such a number.  Internal analysis at ASPE using more recently released projections from CBO suggests that the agency may be assuming a take-up rate among newly-eligible uninsured adults closer to 66-70%.  ASPE lists other estimates of the take-up rate for the expanded Medicaid program under the ACA, from 57% to an unrealistic high of 95% (by the Centers for Medicare and Medicaid Services Office of the Actuary).

While this research brief is technical, it provides a rare occasion for comparing differing estimates for a critical data point within HHS, as well as compared to external researcher estimates.

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