From navigating tax codes to turning bills into laws, the government really knows how to complicate things, and Medicaid enrollment is no exception.

In fact, there’s so much confusion regarding qualifications and application requirements for Medicaid that it scares away many eligible individuals. The Urban Institute estimates that only about 66 percent of Medicaid-eligible adults are enrolled in the program.

The confusion surrounding Medicaid enrollment is also one of the reasons so many employers are overlooking this option for their low-income employees.

For brokers with Medicaid-eligible clients, this means that finding ways to break through the confusion, build trust, and help clients navigate their options should be a top priority.

There are four main areas of confusion surrounding Medicaid options and enrollment that brokers need to clarify for their clients:

1. Clients don’t realize how much money they could be saving.

In the 31 states and the District of Columbia that have expanded Medicaid under the ACA, Medicaid coverage is available to workers making as much as $33,465 per year for a household of four. Yet employers continue to spend billions each year insuring Medicaid-eligible workers and funding their claims.

One national survey found that in 2013, an employer’s average annual cost for private health insurance was approximately $10,800 per employee. However, the typical annual outsourcing cost for Medicaid enrollment is only $200-300 per enrollee. And helping clients enroll their employees in Medicaid will reduce or eliminate clients’ exposure to claims that could negatively impact their insurance rates or budgets.

Educating employers about the money-saving benefits of enrolling eligible employees in Medicaid should be a high priority for brokers. It will prove to clients that you’re a trusted adviser and benefit expert and set you apart in a crowded field.

Begin making Medicaid enrollment a topic in your clients’ annual review and planning session. When you compare the costs, coverage, and employer benefits to private insurance plans, clients will quickly see the value.

2. Clients don’t realize their workers would be better off.

Many employers assume that because their private health insurance is so expensive, it has to be better than Medicaid. But in most cases, this isn’t true.

Medicaid offers no or low premiums and co-pays, no deductibles, coverage for the whole family, and dental and vision insurance for children (and adults in most states). It has a provider network comparable to most employer-sponsored insurance plans.

And more Medicaid recipients are satisfied with their plans than people who purchase private coverage — 87 percent compared to 73 percent.

Brokers can best help clients understand the differences between Medicaid and private insurance by outlining them in a visual way. Utilize webinars, slideshows, charts, and other presentation tools to demonstrate how Medicaid coverage measures up to other options.

3. Clients don’t understand the role they can play in the process.

Because Medicaid isn’t employer-sponsored, many employers believe they have no role in getting employees signed up.

In many cases, they assume their Medicaid-eligible employees have already taken care of enrolling on their own.

But in reality, the confusion around determining qualification and working through the application deters as many eligible individuals as it does their employers.

Working people have a particularly hard time signing up for benefits because they have inflexible schedules and can’t take time off from work. Over the years, my company has encountered innumerable people who either didn’t realize they qualified for Medicaid or couldn’t have completed the application without their employers stepping in.

Employers who want to reap the benefits of moving their eligible employees over to Medicaid must also realize they have a duty (and an interest) in helping those employees through the process.

Brokers should discuss ways they can assist employees, such as allowing employees time off work to visit an adviser or collaborating with a third-party enroller who can walk them through the process.

4. Clients don’t understand why they need help from an expert.

Even if clients understand the benefits of enrolling their employees in Medicaid, there’s still so much about enrollment they aren’t prepared or qualified to handle on their own.

But working with experts allows clients to implement a low-income population management strategy without hitting unexpected roadblocks that waste time and money.

For example, many employers aren’t aware that they can’t legally ask their employees certain questions — or that some employees are unwilling to fully disclose information about their households to their employer.

My company encountered this when working with a past client. One member of the company’s team had recently married but was afraid to tell her employer about the marriage.

Only because of our confidentiality clause did the employee feel safe enough to speak honestly and complete the application process.

The rules around Medicaid qualifications are perplexing, and only Medicaid experts can help clients (and sometimes brokers) understand whether different strategies will work. These experts can take some of the burden off of you and even provide you with some commission for the job.

The confusion surrounding Medicaid enrollment can scare a lot of people away from the program.

That’s why brokers need to go the extra mile to not only explain the program’s benefits to their clients, but also assist them through the application process.

Instant Insights /

Top 4 things about Medicaid enrollment that confuse clients

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