ACA's 'woodwork effect' led to millions accessing Medicaid coverage they were already entitled to: Study

May 01, 2016

The National Bureau of Economic Research indicates that 43% of low-income Americans who signed up for Medicaid in 2014 were already eligible for the program but hadn't signed up because they didn't have to or didn't realize they could. Researchers attribute this to the woodwork effect as outreach efforts around the ACA prompted them to sign up in droves. One of the authors says half of the two million enrollees in 2014 came from Medicaid expansion states, and the other half came from non-expansion states. So far, 30 states and the District of Columbia have expanded Medicaid, with Louisiana set to expand its program beginning in June. Despite many states' refusal to expand Medicaid, enrollment still reached levels that were higher than if all states had expanded. The authors suggest that the woodwork effect led to enrollment expanded in all states, putting a strain on state budgets. Some observers have called the woodwork population a wildcard, noting that projections were off target because it was difficult to predict how many people would take up Medicaid as a result of the publicity around expansion. In some non-expansion states, enrollment grew by as much as 10% in the first three months of 2014.
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