More women than men joining state’s Medicaid

Saturday, January 18, 2014

The more than 71,000 people enrolled in Arkansas’ expanded Medicaid program as of Jan. 2 included twice as many women as men, numbers released Friday by the state Department of Human Services show.

According the department, 66 percent of the 64,872 people enrolled in private, Medicaid-funded plans under the so-called private option were women.

Women also made up 68 percent of the 6,151 newly eligible adults who were assigned to the traditional Medicaid program because they were considered to have exceptional health needs.

The demographics of those who enroll in the private plans, as well as in other coverage offered through the state’s health-insurance exchange, are being monitored in part because the medical costs of those enrollees could affect future premiums.

Under the federal healthcare overhaul and the private option, all the people covered by an insurance company’s plans in the individual insurance market that start this year or in future years are included in the same risk pool, meaning their medical expenses are used to calculate future premiums. That includes those whose premiums are paid by Medicaid, as well as others who sign up for coverage through the exchange or outside of it.

Earlier this week, the Human Services Department released numbers showing that more than half of those who enrolled in the Medicaid-funded plans as of Jan. 2 were under age 40, which state Medicaid Director Andy Allison said “dramatically improves the risk profile” of the population who will be covered by plans on the exchange, and could help entice more insurance companies to offer plans on the exchange in future years.

That’s because young people typically have lower health-care costs than older people.

Young women, on the other hand, typically have higher health-care costs than young men.

“To the degree that that population has a higher percentage than expected of young females than males, the cost could be higher than expected,” said Max Greenwood, a spokesman for Arkansas Blue Cross and Blue Shield.

She said she didn’t know whether her company expected more women than men to enroll when it set its premiums for 2014.

Before this year, insurance companies typically charged young women more than young men to make up for the women’s higher health spending. The Patient Protection and Affordable Care Act, however, prohibits insurance companies from charging women more than men. The law also limits the degree to which insurance companies can charge older people more than younger people.

Numbers released earlier this week show that those who have enrolled in coverage through the exchange and who do not qualify for Medicaid also include more women than men.

In Arkansas, 56 percent of the 12,763 people who signed up for plans on the exchange as of Dec. 28 and who did not qualify for Medicaid were women. Nationally, 54 percent of the 2.2 million people who had signed up for coverage on insurance exchanges were women.

Anna Strong, health-policy director for Arkansas Advocates for Children and Families, said research has shown that women often make health-care decisions for their families, which has led to some of the national outreach efforts aimed at women.

“Women understand the value of health coverage because they are the primary decision-makers when it comes to health care,” Strong said.

Some of the women likely have children who are covered under ARKids First, which is available to children in households with incomes of up to 200 percent of the federal poverty level.

Before Jan. 1, Medicaid coverage for parents was limited to those with incomes of up to 17 percent of the poverty level. The expansion extended eligibility to adults with incomes of up to 138 percent of the poverty level - $15,860 for an individual or $32,500 for a family of four.

“Moms take care of their children’s health-care needs, and so they can see the benefits of ARKids First for their children and are maybe more excited about signing up for something when it first becomes available for themselves,” Strong said.

Women also were heavily represented among those who had been enrolled in programs that were discontinued Dec. 31 as a result of the new coverage options.

Those programs included one that provided contraceptives and other family-planning services for more than 53,000 women, and another that covered the treatment of breast and cervical cancer for 790 patients. Both programs were available to people with incomes up to 200 percent of the poverty level.

The Human Services Department sent notices in September to those who were in the programs with information on how they could sign up for Medicaid or other coverage, depending on the person’s income level.

The department also sent letters to recipients of the Supplemental Nutrition Assistance Program, also known as food stamps, who it determined were eligible for Medicaid coverage. Those letters resulted in about 63,000 people signing up.

Human Services Department spokesman Amy Webb said she didn’t have information Friday on how many food-stamp recipients, including those who received the letters, are women and how many are men.

Under the health-care law, people with incomes below 400 percent of the poverty level - $45,960 for an individual or $94,200 for a family of four - may qualify for federal tax-credit subsidies to help pay their premiums for a plan on the exchange.

The expansion of the state’s Medicaid program made an estimated 250,000 adults eligible for coverage.

A 2012 report by the Urban Institute estimated that men made up more than 51 percent of the eligible population in Arkansas.

Kim Fowler, who supervises outreach workers at the Arkansas Health Care Access Foundation, said she has noticed more women seeking help with enrollment than men.

“Every once in a while, the husband calls, but usually it’s the wife,” Fowler said.

She noted that, since women tend to use more health services, they may have a greater incentive to sign up. Kalena Jones, director of the foundation, said a difference in habits may play a role.

“Men are a little more laid back when it comes to this kind of thing,” she said.

Strong said the men who haven’t applied for the private option might be among the “young invincibles” who think they don’t need coverage. The state should make sure it includes them as a target of its outreach efforts, she said.

“We would love everyone who’s eligible to sign up,” she said.

Front Section, Pages 1 on 01/18/2014