I learned a new health wonk term yesterday, reading the Leavitt report on Medicaid expansion options in Idaho. No one will mistake it for the Bard, but it does a good job of explaining the choices available to Idaho under the Red State Option.
The part that was new to me was the concept of “eligibility surge” – the fact that whether a state takes the non-elderly expansion to 133% FPL or not, other changes in PPACA will make some people newly eligible for Medicaid. Examples include the required use of Modified Adjusted Gross Income (MAGI) and the 5% income offset; the elimination of the asset test; conforming the definition of “household” for Medicaid income eligibility purposes to existing tax rules; and other administrative changes to streamline eligibility determinations. (details here, in Part II.D).
These income eligibility and administrative reforms were NOT affected by the Obamacare decision (NFIB). So the eligibility surge is mandatory, not optional AND qualifies for the 100% FMAP until 2016.
The bottom line? In Idaho, the eligibility surge is expected to be larger than the woodwork effect:
IDHW estimates that the Medicaid provisions outlined above could increase Idaho’s Medicaid enrollment by 5% to 10%, regardless of whether the State decides to expand or not (also known as “eligibility surge” this number does not take into account the newly eligible or the currently eligible, but not enrolled, who may enroll in Medicaid in an expansion scenario). Based on the expected changes to the State’s current eligibility system as well as taking into account enrollment in other state subsidy programs, IDHW estimates Medicaid enrollment could increase by 100,000‒150,000 in an expansion scenario. Roughly 75% of this number is the newly eligible and the remaining 25% comprises the eligibility surge (15%) and the woodwork effect (10%; the currently eligible, but not enrolled).