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Iowa’s Medicaid program may feel coronavirus brunt

Iowa’s Medicaid program may feel coronavirus brunt

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DES MOINES — State officials are bracing for a potential influx of Iowans who have lost their jobs — and their employer-based health insurance — who likely will join the ranks of the uninsured or seek assistance if they meet Medicaid or other program qualifications.

A state-by-state study by Health Management Associates of Michigan estimates the number of Iowans receiving coverage from an employer could decline by between 128,000 and 384,000 — including both workers and family members — under scenarios where unemployment rates in Iowa range from 10 to 25% should businesses fail to survive the COVID-19 pandemic.

Iowa could see an increase of 115,000 Medicaid enrollees, 9,000 more who seek insurance in the Affordable Care Act marketplace and 4,000 who join the ranks of the uninsured under a projection based on the low end of having 10% unemployment.

Up to 265,000 more Medicaid enrollees, 36,000 more seeking private insurance in the marketplace and an increase of 83,000 joining the ranks of the uninsured are predicted if statewide unemployment hits 25%.

Iowa’s latest unemployment rate was just 2.8% in February.

Jess Benson, a Legislative Services Agency staff member who analyzed the recent study, noted that Iowa is in a significantly better position for minimizing the number of uninsured compared with other states that decided not to expand Medicaid under the Affordable Care Act.

Most potential new Medicaid members would likely qualify for the 2013 Iowa Health and Wellness Plan, which has a 90% federal match rate. In addition, according to the agency’s analysis, uninsured individuals may be eligible for Medicaid if they show up at a hospital or other entity for care that has the authority to determine presumptive eligibility.

However, according to the analysis, if individuals become Medicaid-eligible but are unfamiliar with how to access the program or simply go without insurance hoping COVID-19 is a short-term issue, the Medicaid increase could be lower than projected but could lead to a higher number of uninsured Iowans.

Iowa elected officials acknowledged Tuesday they are too early in the process to know how the novel coronavirus pandemic will play out — including how Iowa’s $1.25 billion share from the federal CARES rescue package will fit into this equation as well as the state’s $4 million “stopgap” small-business grants program.

“We’re trying to attack that very issue from a lot of different perspectives,” Gov. Kim Reynolds said during a news conference Tuesday.

Senate President Charles Schneider, R-West Des Moines, said it was “too early to tell” what impact the health crisis would have on Iowa or the state’s fiscal 2021 budget.

But Sen. Joe Bolkcom, D-Iowa City, ranking member of the Senate Appropriations Committee, said that “without a doubt, large numbers of Iowans will lose their health care coverage and will need the support of Medicaid, the Iowa Health and Wellness program and the insurance exchange subsides.”

Nationally, the Health Management Associates study projected the number of people receiving health insurance from an employer could decline by 12 to 35 million and that Medicaid enrollment could rise from 71 million to between 82 and 94 million. The number of uninsured Americans could increase to 40 million, the report said.

“Obviously, unemployment leads to additional people on Medicaid,” Benson said, but he was uncertain how representative the national model would be of Iowa’s specific circumstances.

“I don’t think it’s going to be reflected in our enrollment numbers quite as much as this impact suggests,” he said.

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