April 30, 2015: In a HealthAffairs paper released online today, Lacey Hartman, Giovann Alarcon, Brett Fried, and Julie Sonier (now at Minnesota Management and Budget), present an analysis of eligibility for special enrollment in the ACA Marketplace due to qualifying life events. 

The authors used data from the federal Survey of Income and Program Participation (SIPP) from April 2012 to January 2013 to estimate the numbers and percentages of nonelderly adults (ages 18 to 64) with income changes and other qualifying life events that could trigger eligibility for a special enrollment period. The study found that a large number of people are potentially eligible for special enrollment periods as part of federal and state Marketplaces, and the majority are uninsured.

Findings

• About 16.7 million people experienced a qualifying life event that was not related to an income shift. For example, they lost minimum essential coverage, got married, or became parents of a newborn child.
  • Of these, 8.4 million were potentially eligible to enroll in Marketplace coverage because they were uninsured (6.1 million) or had nongroup coverage (2.3 million) at the end of the study period.
• Approximately 1.9 million people living in states that did not expand Medicaid experienced income shifts outside of the open enrollment period that would make them eligible for Marketplace coverage because their incomes increased above 100 percent of poverty; however, they were not eligible to enroll until the next open enrollment period.
  • In contrast, people living in states that have expanded Medicaid would likely be eligible for a special enrollment period in this situation (when surpassing 138 percent of poverty) because they would have become ineligible for Medicaid--i.e., they would have lost minimum essential coverage, which is a qualifying event for special enrollment.

Overall, the authors' findings suggest that there should be ongoing efforts outside of open enrollment periods to help expand access to coverage and potentially strengthen Marketplace risk pools.