States Can Guide the Poor to Health Insurance

A prominent complaint about the Patient Protection and Affordable Care Act is that it's going to make the health-insurance market too complex for low-income consumers to navigate. But new research from the Urban Institute's Health Policy Center shows that states can develop systems to seamlessly guide these consumers to the best options and get them enrolled.

It's true that the status quo can make it complicated for low-income consumers to obtain health coverage. Many states operate multiple and separate public-assistance programs, most notably Medicaid and the Children's Health Insurance Program, with each generally having different eligibility rules and application procedures.

As a result, many eligible consumers become uninsured because they fail to enroll in the appropriate program or fail to transfer between programs when circumstances change.

Under the health-reform law, states can choose to expand Medicaid eligibility to all poor and near-poor adults. Furthermore, new health-insurance marketplaces will be established in every state, with subsidies available when low-income families aren't offered affordable coverage by an employer.

While the law seems to add more choices and new rules, it also includes measures intended to prevent any confusion that would stymie enrollment. Indeed, the law integrates marketplaces and public health-coverage programs by requiring a single, streamlined application for all health programs.

In other words, whether an application is filed with Medicaid, with a marketplace, in person, online, by phone, or by mail, the same form must be used, and all government agencies must work together behind the scenes to direct each consumer to the coverage options for which he or she qualifies. This requirement is often called "No Wrong Door."

We recently examined the importance of "No Wrong Door" and its implementation in Connecticut.

Connecticut opted to expand Medicaid eligibility, and the state's leaders have committed to fully implement "No Wrong Door" measures by the end of 2015, including integration with social-service programs such as the Supplemental Nutrition Assistance Program and the Temporary Assistance to Needy Families.

Connecticut is ahead of most other states because it has a vision for improving health consumers' experiences, but making the transition to "No Wrong Door" will not be easy or immediate, as state officials have recently emphasized.

Nevertheless, our simulation model suggests that adding "No Wrong Door" to the remainder of the law's requirements will prevent about 36,000 people in Connecticut from losing health coverage for at least part of the year.

"No Wrong Door" could also help outreach programs enroll more qualified people in health coverage, particularly those most discouraged by the complexities of the current programs, such as individuals with different linguistic and cultural backgrounds or less education. Such targeted outreach could increase enrollment beyond the levels simulated.

Although our research focused specifically on Connecticut, the implementation of "No Wrong Door" measures will be important in every state. In fact, "No Wrong Door" requirements apply to all states, whether or not they expand Medicaid eligibility. Therefore, the policy questions addressed in the study are relevant in all states.

Using Connecticut as an example, our research shows that a state thoughtfully implementing "No Wrong Door" measures will significantly increase the number of qualified uninsured who receive coverage under the health law. States should not miss this opportunity to better serve their residents.

Matthew Buettgens is a senior research associate, and Stan Dorn is a senior fellow, at the Urban Institute's Health Policy Center.