Medicaid Expansion’s Impact on Billing and Coding Professionals

The Patient Protection and Affordable Care Act signed into law in 2010 got a lot of attention for the health care exchanges that would be set up by federal or state governments. This is what most Americans think of when they consider this act. However another significant change brought into place by this new legislation was a large expansion of Medicaid.

Established in 1965, Medicaid is essentially a health and medical care program based on the social welfare needs of those who qualify, usually by having limited income. The program should not be confused with Medicare, which is a social insurance program for those aged 65 years and older. Funding for Medicaid is provided by both federal and state sources, and the program is the largest source of funding for healthcare for low-income Americans.

The original Affordable Care Act was intended to expand Medicaid coverage to Americans with incomes up to 133 percent of the federal poverty level. That means a family of two living in the contiguous United States could have qualified for Medicaid coverage if they did not earn more than $20,920.90 annually.

However as detailed in a previous post, this plan to expand Medicaid coverage was disrupted by a Supreme Court ruling that resulted in many states’ governors choosing to opt out of the expansion. Since that writing one additional state has chosen to expand its Medicaid program bringing the current total of states that have continued to opt out to 23. As of the present time since the Affordable Care Act, the expansion of the Medicaid program has brought healthcare coverage to nearly five million additional people. That means one-quarter of the 20 million Americans who have gained healthcare coverage under the Affordable Care Act did so through Medicaid expansion. There are just over five million remaining people who would be covered under Medicaid expansion if their states would opt in to the program.

With these figures the impact of Medicaid expansion is clearly visible. Potentially 40 percent of uninsured Americans will have gained coverage through the expansion of Medicaid as part of the Affordable Care Act. Even at the current 25 percent this number is significant. The expansion of Medicaid in all states would provide billing and coding professionals with approximately 10 million clients with new-found healthcare coverage.

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A significant study that speaks to the potential increase in billing and coding activity that can be generated by Medicaid expansion was conducted in Oregon in 2008. Two years before the Affordable Care Act was signed into law, Oregon provided Medicaid coverage to a group of randomly selected eligible people. One of the purposes of the study was to see how having Medicaid coverage would affect a person’s healthcare habits as compared to those without health insurance. One year later the study had produced some notable results:

  • The people who received Medicaid coverage were found to be 30 percent more likely to be admitted to a hospital from non-emergency room visits
  • The Medicaid recipients were found to be 35 percent more likely to use outpatient care
  • The recipients were found to use prescription drugs 15 percent more often
  • The number of emergency room visits for the Medicaid recipients was roughly the same as those who did not have health insurance

Multiplied over today’s five million additional people covered by the Medicaid expansion, and potentially combined with 5 million additional Medicaid recipients, one can understand why professionals working in the field of medical billing and coding have a strong career outlook in the coming future.