Bill Overview
Title: Freedom to Use Contracted Entities Act
Description: This bill allows state Medicaid programs to contract other entities to make eligibility determinations, as long as the contract does not include incentives with respect to such determinations.
Sponsors: Rep. Carter, Earl L. "Buddy" [R-GA-1]
Target Audience
Population: People who apply for or are reevaluated for Medicaid eligibility
Estimated Size: 70000000
- Medicaid is a joint federal and state program that provides health coverage to over 70 million low-income Americans, including eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities.
- The legislation involves administration of Medicaid eligibility which affects all Medicaid beneficiaries as the determination of eligibility is a necessary step to accessing benefits.
- Contracted entities might streamline or complicate the process of eligibility determination impacting efficiency.
- The legislation could potentially affect new applicants to Medicaid and those currently enrolled who might see changes in how their eligibility is handled.
- This could influence the speed and accuracy of eligibility processes for millions.
- Such an impact would scale similarly outside the US for countries with systems of contracted entities handling social service eligibility.
Reasoning
- The population of interest includes over 70 million people enrolled in Medicaid or applying for it. Not everyone will see an immediate effect, especially those not due for an eligibility review.
- The $20M budget for year 1 suggests a limited scope for implementation, possibly starting with pilot programs in certain states or regions.
- The target group may include individuals currently experiencing inefficient eligibility determination processes. The policy could potentially address these inefficiencies.
- The varying impact will depend on how streamlined the process becomes and the differences in implementation among states due to their discretion.
Simulated Interviews
Unemployed (Texas)
Age: 45 | Gender: female
Wellbeing Before Policy: 3
Duration of Impact: 5.0 years
Commonness: 12/20
Statement of Opinion:
- The process of applying for Medicaid is currently too slow and uncertain. I feel anxious not knowing when or if I will receive benefits.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 3 |
| Year 2 | 6 | 3 |
| Year 3 | 6 | 4 |
| Year 5 | 7 | 4 |
| Year 10 | 8 | 5 |
| Year 20 | 8 | 5 |
Retired (Ohio)
Age: 62 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 10/20
Statement of Opinion:
- I'm worried about administrative changes affecting my eligibility verification. If it speeds up, that'd be nice.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 7 |
| Year 10 | 8 | 7 |
| Year 20 | 7 | 6 |
Part-time worker (New York)
Age: 30 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 3.0 years
Commonness: 15/20
Statement of Opinion:
- It’d be great if my eligibility reviews were less of a hassle. I hope contracted entities don't complicate things more.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 6 | 5 |
| Year 10 | 6 | 5 |
| Year 20 | 5 | 4 |
Disabled veteran (California)
Age: 50 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 5.0 years
Commonness: 8/20
Statement of Opinion:
- Any administrative change could affect disability benefits. Clarity and speed are crucial, so I’m hopeful but cautious.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 6 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 4 |
Student (Florida)
Age: 25 | Gender: other
Wellbeing Before Policy: 4
Duration of Impact: 10.0 years
Commonness: 9/20
Statement of Opinion:
- Applying for continued eligibility feels unpredictable. A contractor-driven process sounds efficient, but what about errors?
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 8 | 6 |
| Year 20 | 8 | 6 |
Self-employed (Arizona)
Age: 38 | Gender: female
Wellbeing Before Policy: 2
Duration of Impact: 5.0 years
Commonness: 13/20
Statement of Opinion:
- I’m stressed about eligibility being determined in time. I hope the changes will make it quicker and less stressful for new applicants.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 2 |
| Year 2 | 6 | 3 |
| Year 3 | 6 | 4 |
| Year 5 | 6 | 4 |
| Year 10 | 6 | 5 |
| Year 20 | 6 | 5 |
Factory worker (Michigan)
Age: 29 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 4.0 years
Commonness: 11/20
Statement of Opinion:
- I hope for fewer bureaucratic delays. The process needs to be less of a time-sink for working people.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 8 | 6 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 7 | 6 |
| Year 20 | 6 | 5 |
Caregiver (Mississippi)
Age: 55 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 5.0 years
Commonness: 7/20
Statement of Opinion:
- If they could simplify my review process, that’d help a lot, especially while juggling caregiving duties.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 4 |
Waiter (Nevada)
Age: 19 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 5.0 years
Commonness: 14/20
Statement of Opinion:
- I’m new to Medicaid, and anything that makes applying easier would be appreciated.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 6 | 5 |
| Year 20 | 5 | 4 |
Teacher (Illinois)
Age: 40 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 6.0 years
Commonness: 6/20
Statement of Opinion:
- As a teacher, time is valuable; faster determination helps me focus more on my career and kids.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 8 | 5 |
| Year 20 | 7 | 4 |
Cost Estimates
Year 1: $20000000 (Low: $12000000, High: $30000000)
Year 2: $18000000 (Low: $10000000, High: $28000000)
Year 3: $15000000 (Low: $8000000, High: $22000000)
Year 5: $12000000 (Low: $6000000, High: $18000000)
Year 10: $10000000 (Low: $4000000, High: $16000000)
Year 100: $5000000 (Low: $2000000, High: $8000000)
Key Considerations
- The legislative impact will be contingent upon state-level implementation of contracted eligibility determination processes.
- There exists potential for variability in efficiency gains per state which affects the overall cost/savings analysis.
- Federal and state oversight mechanisms will be crucial to ensure contracted entities do not compromise eligibility assessment quality.
- Ensuring no incentive-based determinants are included in contracts will be essential to mitigate risks of bias or inaccuracies.