CORRECTION: Medicaid expansion trends are emerging in Maine. Here’s how they’re bucking expectations.
The state has enrolled more than 36,000 people in the program as of last Friday, about half of the 70,000 residents expansion is estimated to cover after implementation earlier this year. Health and Human Services Commissioner
The state appears behind schedule on that mark, but department spokeswoman
Some of the early trends -- including a high number of young adults enrolling -- are surprises. Others, including rural residents making up almost half of enrollees and a high share of people with chronic conditions, may speak to structural challenges to health care access.
Residents of rural counties are signing up at a healthy clip, but there could still be access issues. A study earlier this year from the
Those figures use two different measures to determine whether an area is rural or urban, so they're not directly comparable, but experts said enrollment could be lagging in some rural areas.
It could also be why some of the state's rural hospitals haven't seen a significant financial change since MaineCare's expansion.
Enrollees are also skewing younger than expected, which could indicate a difference in priorities with older people. Only 6.6 percent of new enrollees were expected to be aged 18 to 24, but enrollees aged 19 to 25 have made up one-third of enrollments so far, according to the state. While the
Ziller said it's possible accessing was more of a priority for young rural residents since they are more likely to be uninsured. In general, she said rural areas have more seasonal jobs or those with small businesses that don't provide health insurance.
Those people might wait until "things get really bad" before seeking medical care, she said, or may be hesitant to sign up due to perceived stigma around Medicaid.
"I think to some extent that MaineCare has been portrayed as something that only people who have very few resources should be considering instead of one of many coverage options," Leonard said.
New enrollees are slightly sicker than the rest of the MaineCare population and more likely to need inpatient care. About 61 percent of enrollees reported having one or more chronic conditions common in other MaineCare adults, but in slightly higher amounts, according to the department. Of that population, 20 percent have a substance abuse disorder and 15 percent have an opioid use disorder, compared to 14 percent and 12 percent in others.
Other conditions more common among the expansion group include mental illnesses, diabetes, heart disease, chronic obstructive pulmonary disease and hypertension. New enrollees are also more likely to use an emergency room, a possible result of chronic conditions.
This could be another example of the barriers
That means enrollees are more likely to have skipped care that may have prevented their conditions from becoming worse, leading them to need more intensive upfront care, according to a recent update from the department.
Correction: An earlier version of this story conflated two measures of rural populations eligible and signing up for Medicaid expansion. A study found roughly 80 percent of the population eligible for MaineCare expansion lives in rural areas based on zip code data, while 48 percent of rural enrollees so far live in
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