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Massachusetts Data Hints That States Will See Large ACA Medicaid Expansion


Bethesda, MD -- In many states, a large share of the uninsured population is made up of those eligible for Medicaid but not enrolled. With the implementation of the Affordable Care Act, states -- even those not expanding Medicaid eligibility -- are likely to experience increased program participation. A new study, being released today as a Web First by Health Affairs, looks at Massachusetts's 2006 health reform efforts to shed light on what states can expect in the months ahead. The study analyzed Medicaid's "welcome-mat" effect in the Bay State and found that enrollment among low-income parents previously eligible for Medicaid increased by 16.3 percentage points, and participation by those without private coverage increased by 19.4 percentage points.


Comparing the trends in neighboring states of New York, Maine, Vermont, and Rhode Island, the authors reviewed data on health insurance from the Annual Social and Economic Supplements to the Current Population Survey in these states for the years 2003 to 2011, four years prior to and five years after the implementation of the Massachusetts health reform. Since Massachusetts already had a high Medicaid participation rate, authors note that other states could see an even larger welcome-mat effect.

Medicaid 'Welcome-Mat' Effect Of Affordable Care Act Implementation Could Be Substantial


By Julie Sonier, Michel H. Boudreaux, and Lynn A. Blewett


The authors are affiliated with the State Health Access Data Assistance Center at the University of Minnesota in Minneapolis.


The study, which will also appear in the July issue of Health Affairs, was supported by a grant from the Robert Wood Johnson Foundation.


The authors' findings have potentially important implications for other states, especially in anticipating how this welcome-mat effect will affect state budgets. For states' planning purposes, other factors that will cause variation in the welcome mat are the intensity of a state's outreach efforts and the simplicity of the enrollment process. "Our analysis provides new evidence that can be incorporated into models that project the impacts of policy changes on Medicaid enrollment," the authors conclude.

About Health Affairs

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print, with additional Web First papers published periodically at The full text of each Health Affairs Web First paper is available free of charge to all website visitors for a one-week period following posting, after which it switches to pay-per-view for nonsubscribers. Web First papers are supported in part by a grant from The Commonwealth Fund. You can also find the journal on Facebook and Twitter. Read daily perspectives on Health Affairs Blog. Download our podcasts, including monthly Narrative Matters essays, on iTunes. Tap into Health Affairs content with the new iPad app.