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Key Findings from the Field: Early Experience with ACA Enrollment in Maryland and Nevada

On October 1, 2013, open enrollment began for new Health Insurance Marketplaces established under the Affordable Care Act (ACA). To learn more about the early ACA enrollment experience in two states, the Kaiser Commission on Medicaid and the Uninsured and PerryUndem Research and Communication conducted focus groups in Baltimore, Maryland and Reno, Nevada in November 2013 with low- and moderate-income individuals who recently applied for health insurance and consumer assisters trained to help individuals enroll. This study builds on previous work that examined preparations for open enrollment in several states, including Maryland and Nevada, which are both moving forward with the ACA’s Medicaid expansion to low-income adults and have established their own State-based Marketplace (SBM).1  At the time of the study, both states were working through significant problems with their Marketplace websites that hampered enrollment. The focus group discussions included only adults who had successfully applied as well as consumer assisters to gain a greater understanding of these individuals’ experiences. Further, since they reflect the experiences of individuals in these states who sought coverage, they are not representative of the uninsured population.

The recent applicants in the focus groups were low- and moderate-income adults within the income range to qualify for Medicaid (up to 138% FPL) or for tax credit subsidies for Marketplace coverage (139%-400% FPL). Participants in the two consumer assister focus groups included a diverse set of individuals who are helping to reach and enroll eligible uninsured individuals in their communities. They included Navigators in Maryland and Navigators, application assisters, and insurance brokers in Nevada. The assisters reported helping a broad range of people determined eligible for Medicaid, tax credits, and unsubsidized Marketplace coverage under the ACA. Many noted that a large share of people they were helping were found eligible for Medicaid, reflecting the fact that the Medicaid expansion significantly expands eligibility levels for adults. Following are key findings about the early ACA enrollment experience in Baltimore, Maryland and Reno, Nevada based on focus group discussions with these recent applicants and enrollment assisters.

Key Findings