A Guide to Medicaid Migration for Low-Income Workers

Helping low-earners enroll in Medicaid can save small companies considerable money on health care

By Benjamin Geyerhahn Oct 16, 2015

Benjamin Geyerhahn is CEO of Benestream, a provider of benefits administration technology. He is a member of New York Gov. Andrew Cuomo’s Health Benefit Exchange Regional Advisory Committee.

Easing difficulties with the Medicaid enrollment process for low-income employees can save small companies considerable money on health care costs while keeping employees compliant with the Affordable Care Act’s (ACA’s) individual mandate.

To reap these benefits and improve the lives of their employees, companies with fewer than 50 full-time employees (and therefore not subject to the ACA’s mandate to provide health coverage to all full-time workers) should consider a formal Medicaid migration process to educate low-income employees about the Medicaid option.

The Advantages of Medicaid Migration

More working-age Americans had health insurance last year due in part to the growth of publicly financed care such as Medicaid, according to an October 2015 report by the nonprofit Employee Benefit Research Institute, which showed that:

21.7 percent of the nonelderly population received coverage through Medicaid in 2014, up from 19.4 percent in 2013.

The percentage with employment-based health coverage was unchanged at 62 percent.

A study by ADP, a payroll services firm, found that 82 percent of employees earning $45,000 or more participated in employer health plans. But, as income fell below $45,000, participation declined steeply, reaching a rate of only 37 percent for eligible single full-time employees earning between $15,000 and $20,000 per year.

Medicaid eligibility varies among the states based on income as a percent of the federal poverty level. Benefits also vary, but in many states Medicaid provides comprehensive and inexpensive health insurance—including vision and dental coverage for all family members. It’s an option for individuals who can’t afford coverage through their employer’s health plan but might consider purchasing it anyway to avoid ACA penalties for being uninsured.

Unfortunately, the experience of applying for Medicaid is difficult to navigate. When implementing programs to assist low-income employees with public benefits, HR can provide a better user experience with four simple steps:

1. Start with new hires

If migrating a large chunk of your existing workforce to Medicaid is intimidating, start by offering the Medicaid option to eligible new hires. This way, they likely won’t opt into your insurance in the first place. And because employees are more benefits-focused during the onboarding process—and likely already have many of the documents needed for the application—it makes more sense from a logistical standpoint.

2. Reframe the conversation, and educate your employees

A crucial component of Medicaid migration processes is how you approach your employees. You should treat Medicaid just like any other workplace benefit by thoroughly educating workers about it. Start by gathering potentially eligible employees to inform them of this option and why it is potentially beneficial for them.

Although the topic of Medicaid makes some employers uncomfortable, your employees may not feel the same way. A recent survey by YouGov revealed that 62 percent of Americans don’t think people should be ashamed of using public benefits. These numbers likely are higher among lower-income staff members who have encountered public programs either directly or through people they know.

If you set the right tone from the beginning, you’ll smooth out any potential wrinkles in the process and see greater participation overall. On the other hand, if you appear uncomfortable with the topic, many employees will pick up on this and shy away from Medicaid. This high-quality, affordable option should be a welcome addition to the menu of available workplace benefits, so it’s important to position it that way.

Just make sure that you never pressure your employees to opt out of the company plan or provide an incentive for them to do so.

3. Follow up with employees

Even if you work with a third-party vendor, your representative might ask for help reaching out to employees who haven’t completed all the steps in the enrollment process. Your assistance is crucial for getting in touch with employees who might not have reliable phone or Internet access at home or who work multiple jobs and don’t have much downtime. It could mean the difference between moving employees from “eligible for” to “enrolled in” Medicaid and could help avoid added costs to your company plan.

Remember, the people who lack the time, resources or knowledge to go through this process on their own are the ones you most want to complete the Medicaid migration process. Without help navigating the details and accessing tools to enroll, many employees will stick with whatever plan you provide, annually costing your company thousands of dollars.

4. Provide assistance through the renewal process

It’s not enough to get employees on Medicaid. You will need to assist them with annual Medicaid renewal to make sure all eligible employees stay enrolled.

Many people drop off during the Medicaid renewal process simply because they haven’t received the proper guidance for submitting the documentation they need to stay in the program, and the renewal process can be confusing. However, you can help by putting in place procedures to proactively track and assist with renewal.

By educating your employees about their options, you can enhance your workers’ lives while supporting your company’s bottom line.


The application deadline is November 11

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