ACA Marketplace Take-Up Was High After Facilitated Enrollment In California; Disparities Remained

Area of Science:

• Health Services Research
• Public Health Policy
• Health Insurance Access

Background:

• The COVID-19 public health emergency unwinding led to significant Medicaid disenrollment.
• California implemented a facilitated enrollment program for individuals losing Medicaid.
• Understanding coverage transitions is crucial for public health policy.

Purpose of the Study:

• To assess health insurance coverage outcomes for Californians who lost Medicaid.
• To evaluate the effectiveness of California's facilitated enrollment program.
• To identify disparities in enrollment among different subpopulations.

Main Methods:

• A survey was conducted in 2023-24 among Californians who lost Medicaid coverage.
• Participants were assigned a default plan with a 30-day opt-in period.
• Analysis included factors like income, education, health status, and race/ethnicity.

Main Results:

• 85% of eligible individuals obtained some form of health insurance.
• Nearly two-thirds opted into a Marketplace plan when no other coverage was available.
• Lower enrollment rates were observed among those with less education, poor health, Hispanic/Latino, and Black/African American individuals.

Conclusions:

• Facilitated enrollment programs can improve insurance continuity after Medicaid loss.
• Targeted interventions are needed to address enrollment barriers for vulnerable subpopulations.
• Addressing administrative burdens is key to equitable access to subsidized health insurance.