Why state healthcare saw record levels of enrollment this year
After the unwinding of federal pandemic-era healthcare provisions, record numbers of Connecticut residents are turning to Access Health CT for health insurance.
Daniel Zhao, Senior Photographer
Record numbers of Connecticut residents are seeking health insurance for 2024 through the state’s health insurance marketplace.
During this year’s Open Enrollment period, which began on Nov. 1, 2023 and ended on Jan. 15, 2024, the number of people who enrolled in qualified health plans through Access Health CT, the state’s official healthcare exchange, increased by nearly 20 percent to 129,000, according to Access Health CT. It’s the highest level of enrollment since the state marketplace opened in 2013.
Among the new enrollees are over 27,000 residents enrolled through the Covered CT program, which provides no-cost coverage to eligible Connecticut residents since the state pays consumer premiums and other costs, according to a news release from Access Health CT. Compared to the prior enrollment period, with a little over 15,400 Covered CT beneficiaries, the new enrollment numbers represent over a 75 percent increase.
Over 14,000 are also enrolled in dental coverage through Access Health CT.
Several state officials told the News that the marketplace has become more popular due to Medicaid unwinding, a process in which continuous eligibility provisions in the state’s Medicaid program, previously expanded during the pandemic by federal provisions, are set to expire.
“During the public health emergency, there was the continuous coverage provision, meaning anybody who became eligible for Medicaid maintained their coverage, even if they no longer qualified,” Caroline Ruwet, director of marketing for Access Health CT, told the News.
Creating Access Health CT
The passage of the Affordable Care Act spurred the creation of healthcare marketplaces — or exchanges — of federally-approved health insurance plans that insurance companies are incentivized to offer. In response, Connecticut created Access Health CT a few years later, offering people access to a variety of subsidized health insurance plans.
The legislation also required insurance companies to adopt an “open enrollment” period during which people can apply for different health insurance plans on the exchanges. Access Health CT, Connecticut’s version of the ACA exchange, directly compares health insurance plans for eligible Connecticut residents. The platform also helps qualified residents to apply for HUSKY, Connecticut’s Medicaid program.
“[The marketplace] allows folks who don’t qualify for Medicaid but are still in need of reduced cost health care to get a plan on Access Health,” said Connecticut State Rep. Jillian Gilchrest.
According to Howard Forman, professor of economics and public health, marketplaces like Access Health CT play a key role in the American health insurance landscape. The marketplaces provide a bridge for individuals who do not have employer-sponsored health insurance or cannot afford health insurance but still don’t meet the eligibility requirements for Medicaid.
Ruwet said the Access Health CT application requires individuals to indicate their income, the number of people in their home and their address to confirm they are a Connecticut state resident.
Based on the application, the system then offers subsidies to people depending on their need. If applicants are in greater need, the Connecticut state government will offer more financial assistance, including via the Covered CT program.
The government subsidizes health insurance plans depending on how far above the poverty line the household is. The marketplace provides a sliding scale subsidy from 125 percent of the federal poverty level up to 400 percent of the federal poverty level, said Forman.
According to Ruwet, 80 percent of people on the CT exchange receive financial help.
“When we think about what can you do for this group of people — who don’t work for a large employer or who might be an entrepreneur or who might work a retail bakery or own their own business — [these people] should be able to have access to health insurance,” Forman said. “And this is one more way for it.”
Medicaid unwinding and increased enrollment
In response to the COVID-19 pandemic, Congress passed the Families First Coronavirus Response Act in 2020, which required that states keep Medicaid beneficiaries continuously enrolled through the end of the federal public health emergency so that states were prohibited from regularly reevaluating individuals’ eligibility.
In return, states received enhanced matching funds for their Medicaid programs. Individuals could remain enrolled in Medicaid programs even if their standard Medicaid eligibility fluctuated due to changing income or other life circumstances.
However, in April 2023, continuous coverage policies expired as the federal government announced the end of the public health emergency the following month. The announcement halted the federal policy that allowed people to stay on Medicaid, even if they were no longer qualified.
Now, Connecticut is in its 12-month unwinding process, disenrolling people from Medicaid who lost eligibility during the pandemic. In turn, many are looking for other health insurance options, such as the Access Health CT exchange.
“In the environment where Medicaid disenrollment is happening right now, there’s a heightened awareness of how to make sure that people who may have been disenrolled from Medicaid appropriately find themselves on the exchanges now,” Forman said.
According to Ruwet, the marketplace supports these transfers in coverage. The unwinding of pandemic-era policies likely contributed to higher enrollment for Access Health CT, as state health insurance marketplaces filled the gap for individuals looking for subsidized health insurance.
She noted that many customers started the Open Enrollment cycle in May 2023 on Access Health CT.
“A lot of people were coming off of Medicaid but didn’t qualify for an employer option,” Ruwet said.
Spreading the word
Every year during the Open Enrollment period, the state organizes a large marketing and outreach campaign to encourage insurance applications.
Beginning in the spring of 2023 and through the Open Enrollment period, Access Health CT has hosted daylong outreach and enrollment fairs to offer free, in-person enrollment help for individuals at risk of losing coverage during Medicaid unwinding.
The organization also says that it has trained and licensed 50 new health insurance brokers through its “Broker Academy,” a program in which the state provides free training and covers licensing exam costs for prospective health insurance brokers. The brokers work statewide to help insurance applicants compare insurance plans and navigate the application process, including at outreach events, Access Health CT wrote in a news release.
The organization attributes increased enrollment, in part, to these targeted advertising and recruitment efforts. Access Health CT’s Health Equity and Outreach team also specifically targets underserved communities, Ruwet said.
According to Ruwet, many of the communities that Access Health CT targets have historically lacked access to affordable healthcare. The team works to reduce racial health disparities by promoting the marketplace in these communities and offering them the tools for enrollment, she said.
“We partner with over 2,000 community partners throughout the entire year,” Ruwet said. “We work with a lot of nonprofits that are already in communities that people already go to and kind of trust.”
These organizations include local community health centers and other nonprofits that provide assistance services. Ruwet noted Access Health CT trains workers at these organizations not only to spread awareness about the marketplace but also to help people directly enroll in health care coverage.
“It takes the dedication and hard work of many to achieve these enrollment numbers,” said James Michel, the CEO of Access Health CT, in a news release. “I am proud to work with people who believe in our mission and understand the importance of health insurance coverage for everyone in Connecticut.”
The Affordable Care Act was passed in 2010.
Correction, Feb. 12: This article has been amended to correct what were mostly typographical errors.