title: Wisconsin's experience with Medicaid auto-enrollment: lessons for other states.
abstract: The Patient Protection and Affordable Care Act (ACA) relies heavily on the expansion of Medicaid eligibility to cover uninsured populations. In February 2008, Wisconsin expanded and reformed its Medicaid/CHIP program and, as part of program implementation, automatically enrolled a set of newly eligible parents and children. This process of "auto-enrollment" targeted newly eligible parents and older children whose children/siblings were already enrolled in the state's Medicaid/CHIP program. Auto-enrollment brought over 44,000 individuals into the program, representing more than 60% of all enrollees in the first month of the reformed program. Individuals who were auto-enrolled were modestly more likely to leave the program relative to other individuals who enrolled in February 2008, unless their incomes were high enough to be required to pay premiums; these auto-enrollees were much more likely to exit relative to other enrollees subject to premium payments. The higher exit rates exhibited by non-premium paying auto-enrollees were likely due to the fact that over 40% of auto-enrollees were covered by a private insurance policy in the month of their enrollment, compared to approximately 30% for regular enrollees. A national simulation of an auto-enrollment process similar to Wisconsin's, including the expansion of adult Medicaid eligibility to 133% of the federal poverty level under the ACA, suggests that 2.5 million of the 5.6 million newly eligible parents could be auto-enrolled, and approximately 25% of this population would be privately insured. These results suggest that auto-enrollment may be appropriate for other states, especially in their efforts to enroll eligible populations who are not subject to premium requirements.
authors.affiliation: University of Wisconsin-Madison.
authors.forename: Thomas
authors.initials: T
authors.lastname: DeLeire
authors.affiliation: University of Illinois-Chicago.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Leininger
authors.affiliation: University of Wisconsin-Madison.
authors.forename: Laura
authors.initials: L
authors.lastname: Dague
authors.affiliation: Congressional Budget Office.
authors.forename: Shannon
authors.initials: S
authors.lastname: Mok
authors.affiliation: University of Wisconsin-Madison.
authors.forename: Donna
authors.initials: D
authors.lastname: Friedsam
mesh_terms: D002648:Child; D004608:Eligibility Determination; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008484:Medicaid / Q000458:organization & administration* / Q000706:statistics & numerical data; D058991:Patient Protection and Affordable Care Act / Q000458:organization & administration; D011203:Poverty; D014481:United States; D014922:Wisconsin / Q000453:epidemiology
keywords: Medicaid; auto-enrollment; enrollment; parents