ACA, Medicaid Enrollment and the Woodwork Effect

The Supreme Court upheld the Affordable Care Act with one major exception; it declared that states did not have to expand their Medicaid eligibility rules.

However, the ACA may have indirectly increased Medicaid enrollment even in States that did not change their eligilbity rules.

Avalere Health reports that:

17 of the 26 states that did not expand Medicaid in the first three months of 2014 still reported growth in Medicaid enrollment, ranging from 0.1 percent in Texas to 10.1 percent in Montana. Since these states had decided not to expand Medicaid eligibility levels under the Affordable Care Act (ACA), these numbers show the impact of the “woodwork effect,” which is when individuals who were previously eligible, but not enrolled in Medicaid, newly sign up as a result of increased outreach and awareness.

Some additional statistics from their report:


State Woodwork Beneficiaries % Increase in Enrollment
Georgia 98,800 5.8%
North Carolina 58,000 3.3%
Tennessee 53,700 4.3%
South Carolina 53,600 5.4%
Indiana 45,000 4.0%
Pennsylvania 41,000 1.7%
Oklahoma 38,300 4.8%
Virginia 36,600 3.6%
Michigan 30,400 1.6%
Kansas 22,500 5.7%
Idaho 19,000 7.5%
Mississippi 17,800 2.5%
Montana 14,100 10.1%
Utah 10,400 3.2%
New Hampshire 7,600 6.0%
Texas 3,200 0.1%
South Dakota 0,200 0.2%
Total 550,300 2.8%



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