States struggle to collect Medicaid premiums added under ACA expansion: 6 things to know

While some states made premiums part of their Medicaid expansion programs, few enrollees are making the payments, according to a Kaiser Health News report.

Here are six things to know.

1. The ACA allowed states to expand Medicaid to all people earning less than 138 percent of the federal poverty level, including nondisabled adults.

2. In a move supported by conservatives, some states — such as Arkansas, Indiana, Michigan, Iowa and Montana — chose to expand Medicaid with the inclusion of monthly premium provisions, according to the report. Not all Medicaid beneficiaries have to pay premiums, however, and rules vary in different states.

3. For instance, in Arkansas, the premiums only apply to Medicaid recipients whose income exceeds the poverty level, and enrollees aren't kicked off for failure to pay, reports KHN. Indiana does lock out enrollees for six months if they don't pay their premiums. Montana and Iowa drop Medicaid enrollees with unpaid premiums, but beneficiaries can re-enroll whenever they choose, according to the report. In Iowa, premiums are waived for beneficiaries who fill out a health risk assessment form. Beneficiaries in Michigan normally asked to pay 2 percent of their income in premiums can see a lower fees if they also fill out a health risk assessment form.

4. Enrollees in many states aren't paying the premiums. About 25,000 adults were locked out of Indiana Medicaid from fall 2015 to October 2017 for not paying premiums. In Iowa, 14,000 beneficiaries were disenrolled from January 2016 to September 2017 for the same reason, and Montana dropped 2,884 adults earning above the poverty level last year for not paying, according to the report, which cites state records. Only 20 percent of Arkansas beneficiaries paid the $13 monthly premiums last year.

5. Medicaid advocates in Arkansas said this trend makes sense because low-income recipients often can't afford to pay after taking care of other expenses, according to the report. Conservative supporters in states with premiums have said the payments are meant to promote healthier behaviors.

6. Methods used in Michigan to motivate beneficiaries to make the payments include garnishing lottery winnings and tax refunds, according to the report.

Read the full KHN report here.


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