Medicaid's growth presents unique challenges

Expansion of Medicaid remains a huge part of health care ­reform. There has been a surge in Medicaid rolls, with about 6.3 million more people deemed eligible as of mid-January. Adults at or below 138% of the federal poverty level (FPL) can now sign up; before the ACA’s passage it was 106%.

Covering this population presents unique challenges, according to a survey by the Kaiser Family Foundation that “shows that almost half (47%) of uninsured ­report being uninsured for five years or more, and 18% report that they have never had coverage in their lifetime.”

There are gaps in coverage, even for insured adults, says the study. That’s even more pronounced for Medicaid recipients or those in nongroup coverage. “The most frequently reported services people say they need but lack coverage for are ancillary services such as dental, vision care, and chiropractic services,” says the study. “Lack of coverage for adult dental services in Medicaid — the most frequently reported service needed but excluded from coverage — had been a longstanding issue facing beneficiaries and providers, despite a particularly high need among the low-income population.”

Insured adults are much more likely to get care at doc offices than either the uninsured or Medicare beneficiaries. “Notably, 20% of uninsured adults report the emergency room as their usual source of care — almost double the share of adults with Medicaid and 10 times higher than adults with employer coverage.”

Length of time without coverage — currently uninsured adults

Note: Adults are ages 19–64

Problems with coverage — insured adults

Type of place used for usual source of care

Source: “The Uninsured at the Starting Line: Findings From the 2013 Kaiser Survey of Low-Income Americans and the ACA,” February 2014

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