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Wednesday, March 26, 2014

Two States Use Targeted Enrollment Strategies to Increase Enrollment in Health Insurance

Talia Schmidt


Last month, four state Medicaid directors joined Families USA in a conference call to share their successes enrolling residents in the health insurance marketplace and Medicaid. 

Washington, Oregon, Kentucky, and West Virginia all have state-run health insurance marketplaces. Two of those states (Oregon and West Virginia), in an effort to boost the number of residents who have health coverage, are piloting an innovative “fast track” approach to Medicaid enrollment—one that accelerates enrollment by sparing states the administrative time and costs of handling separate applications for multiple programs (such as SNAP and Medicaid). The Department of Health and Human Services (HHS) has been actively encouraging state Medicaid directors and health officials to try out this streamlined enrollment model (also known as “enrollment accelerators”). In this post, we walk you through how two states enacted this pilot model, and share the increase in health insurance enrollment that resulted from this new approach.

How “fast-track” Medicaid enrollment works

In states that have expanded Medicaid, most participants in the SNAP program (also known as “food stamps”) are also likely to qualify for Medicaid health insurance (the income and eligibility thresholds are similar). States can simply review their SNAP rolls and make preliminary determinations for Medicaid eligibility without waiting on individuals to apply, thus reducing the number of uninsured residents and—as important—reducing administrative time and costs incurred in paperwork and communication with clients. Another group that can be “fast tracked” into Medicaid is parents of children who have Medicaid or CHIP coverage. In many states, many parents are eligible for Medicaid this year for the first time.

How Oregon and West Virginia rolled out their fast-track Medicaid enrollment model

Oregon and West Virginia contacted SNAP enrollees who were uninsured and let them know that they might also qualify for health coverage through the state’s Medicaid program. The outreach was conducted through the mail, and residents were asked to simply mail back a letter or follow up with a phone call to confirm enrollment in Medicaid. In West Virginia’s case, the state also identified parents of children who had signed up for Medicaid and CHIP (the health insurance program for children).

How did accelerating Medicaid enrollment reduce the number of uninsured residents in these states?

  • Oregon: According to Judy Mohr Peterson, Director of the Medical Assistance Programs at the Oregon Health Authority, the state sent out 325,000 letters to consumers with SNAP around Oregon, inviting them to respond to enroll in the Oregon Health Plan. Of those, about 18,000 were bad addresses but the rest went through successfully. There are now more than 194,000 on Oregon’s Health Plan, 123,000 of which were from the expedited enrollment. This means, essentially, 45 percent of people who got the letters responded and signed up.
  • West Virginia: According to Jeremiah Samples, Assistant Secretary for the West Virginia Department of Health and Human Resources, the state estimates that it can cover roughly 135,000 additional people due to Medicaid expansion in their state.

West Virginia
  • State health officials identified 118,000 people who had SNAP, or whose children had Medicaid or CHIP, eligible for health insurance under the new Medicaid guidelines. Officials mailed letters asking potential enrollees to enroll in Medicaid. They enrolled 70,000 people from this process alone—so 59 percent of people who got the letters responded and were efficiently enrolled. 

More on how Medicaid enrollment accelerators work:

An introduction to all enrollment accelerators: “States Have Low-Cost Options to 'Fast-Track' Medicaid Enrollment and Retention”

Accelerating Medicaid enrollment through the SNAP program: “Using SNAP (the Supplemental Nutrition Assistance Program) to Enroll Adults in Medicaid” 

Families USA supports HHS’s efforts to encourage states to adopt “fast-track” policies to help get as many people as possible covered in both the health insurance marketplace and Medicaid. If you want to join with other advocates pursuing fast track enrollment techniques, contact Stephanie Cohen at Families USA scohen(at)  

Effective as of February 20, 2014, via teleconference call with Families USA. These numbers have changed.