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A new study says nearly half of Iowa's non-elderly uninsured are eligible for Medicaid, one of the highest rates in the nation.

The Kaiser Family Foundation this week released a state-by-state analysis, which said 188,000 non-elderly are uninsured in Iowa, and 47 percent of them are eligible for Medicaid, the program that is run jointly by the federal government and the states to provide coverage for the low-income and disabled people.

Expanding Medicaid eligibility was a key part of the Affordable Care Act, and Iowa's enrollment figures have increased significantly.

Iowa was one of 30 states that expanded Medicaid eligibility, which previously had been limited to people who fit into certain categories.

Now, low-income adults qualify.

Iowa's low wages relative to other states may partially explain why there is a higher percentage of the uninsured who are Medicaid-eligible. But some, including some legislative Democrats, think a more robust enrollment effort would help.

Amy McCoy, a spokeswoman for the Iowa Department of Human Services, noted that the state has one of the lowest uninsured rates in the nation and that the department is constantly meeting with stakeholders.

She added some people just don't want to sign up for Medicaid, including in rural areas where people may not want their estates to be subject to the state's estate recovery program.

"Not everyone wants to be involved," she said.

Meanwhile, Sen. Joe Bolkcom, D-Iowa City, said the chances of getting more people into the program will be difficult, given the state's move to shift management of the Medicaid program to a handful of private companies.

The change is slated to take place in January.

"They’re not going out looking for people that need health care," he said. "The winds are blowing in the opposite direction."

Legislative Democrats have been critical of the shift to managed care, which was initiated by Gov. Terry Branstad.

McCoy said the department would maintain control of eligibility and enrollment functions.

Sixteen percent of Iowans who are not insured are eligible for tax credits, the Kaiser study said. The credits are aimed at defraying the cost of premiums for people who buy insurance on their own, and those premiums will see double-digit increases in Iowa's marketplace in 2016.

Another 38 percent of the uninsured in Iowa are not eligible for financial assistance because of their incomes, immigration status or because they are eligible for employment-based coverage, the study said.

The Kaiser study comes as the third year of enrollment is set to begin in the Affordable Care Act's marketplaces. The enrollment window this year is from Nov. 1 to Jan. 31, 2016, although people can enroll in Medicaid year-round.

Nationwide, the Kaiser study said, about half the 32.3 million non-elderly uninsured qualify for government assistance, either through Medicaid or via the tax credits.

About 40 percent of the people who qualify for assistance live in five states: California, Florida, New York, Texas and Pennsylvania. The study said 10 percent of the uninsured, or 3.1 million people, fall into the gap where they earn too much to qualify for Medicaid but not enough to get tax credits.

The gap exists in the 20 states that did not expand their Medicaid programs. People who are below the poverty line are not eligible for the tax credits because the law envisioned they would be covered by Medicaid. A Supreme Court decision, however, gave states the option whether to expand.

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