Medicaid unwinding, enhanced subsidies contribute to ‘significant’ increase in ACA plan enrollment

As of last month, more than 46,000 West Virginians had signed up for health insurance plans on the federal government’s marketplace Healthcare.gov, an increase from the approximately 27,000 who enrolled in the same time period last year. 

The increase is driven partly by the more than 100,000 people who were removed from the state’s Medicaid or Children’s Health Insurance Programs last year as the program returns to pre-pandemic rules and the state reassesses who’s eligible, a health policy analyst said.

“In West Virginia, we know that 6,969 people transitioned from Medicaid to Marketplace coverage between April and September 2023,” said Louise Norris, a health policy analyst for the health insurance guide Healthinsurance.org. “Assuming most of them renewed their coverage for 2024, that would account for a significant chunk of the year-over-year enrollment growth, and it doesn’t include all of the people who made that transition in the final quarter of 2023.”

Open enrollment for 2024 coverage ended Jan. 15. 

Jeremy Smith, program director for WV Navigator, a grant-funded program that helps people sign up for health insurance, said several factors contributed to the increase. 

“I think that a lot of it is people coming over from the Medicaid unwind, for sure,” Smith said. “And we’ve done a really good job of promoting the Marketplace as an option if people lose their coverage.”

During the COVID-19 public health emergency, in order to receive enhanced federal funding, West Virginia and other states were prohibited from removing people from Medicaid or CHIP even though they may no longer have been eligible. Over those three years, the program’s rolls swelled by 30%, with 656,269 in December 2022. Beginning in April last year West Virginia started sending renewal letters to recipients to reassess who’s eligible. 

According to West Virginia Department of Human Services spokeswoman Whitney Wetzel, between April 2023 through December 2023, approximately 175,000 West Virginia residents were found to be no longer eligible for Medicaid or the Children’s Health Insurance Program during the renewal process. In the same time period, the state’s total Medicaid enrollment numbers decreased only by 129,000 because of reenrollments and new applicants, Wetzel said. 

Across the country, more than 20 million people enrolled in health insurance plans on the federal or state-based exchanges, a number the federal government called a record high. 

“Nationwide, more than 14 million people have been disenrolled from Medicaid since the unwinding began,” Norris said. “Although many of them are now eligible for employer-sponsored coverage, the availability of affordable Marketplace plans is important for those who are not and thus need to obtain their own replacement coverage.”

Enhanced subsidies for Marketplace plans under the American Rescue Plan and Inflation Reduction Act are also likely a factor into the enrollment growth, Norris said. 

“Although these subsidy enhancements took effect in mid-2021, awareness of them continues to grow,” she said. 

With the subsidies, nationally, on average four out of five people can find a plan starting at $10 per month, Smith said. 

“You may choose not to go with that under $10 a month, and you may want to pay a little bit more to get a lower deductible and lower copays, so it just is a little bit different for everybody based on their needs,” he said. “But it really truly has made a huge difference here in the state when they brought in those enhanced subsidies for the marketplace plans.”

Smith said the state put contact information for WV Navigator program in the letters alerting people that their Medicaid or CHIP coverage had ended, and a banner ad for the program on the state’s PATH website, where people apply for Medicaid coverage. 

Under the Biden administration, the Centers for Medicare and Medicaid Services did a “wonderful job” advertising the Marketplace with clever TV commercials, online ads, email ads and text messages during enrollment period, Smith said. 

Two companies, CareSourse and Highmark Blue Cross Blue Shield, offer plans on West Virginia’s Marketplace.

“On the state level, the plans are just really well designed this year,” Smith said. “If people actually come in, and they look at the insurance plan options, everybody we’re talking to seems to be very happy with the options they have, just because the actual pricing is good, the premiums are really low. Or also if they’re looking for low deductible plans, there’s several options for low deductibles, even zero deductible plans.”

Smith said West Virginia’s “culture of working together” has also contributed its success in enrolling people, Smith said. 

“We’re a small state, everybody knows everybody, and so we have been able to easily partner with the Medicaid office, and also the Office of the Insurance Commissioner, and the Primary Care Association and community health centers across the state,” he said.