By NextBestFitPhase 1: Enactment & build · Step 1.4
Enroll everyone automatically
Months 6–18 for Wave 1, then before each wave · UHA, SSA, IRSDiscuss this step
Pros & cons of this step
Pros
- +Ends coverage churn: today millions lose Medicaid each year at redetermination, often for paperwork reasons. About 25 million people were disenrolled in the 2023–24 Medicaid 'unwinding'.
- +No premiums to collect from individuals at enrollment means no enrollment gaps.
Cons
- −A national enrollment file linking SSA, IRS, and health data raises privacy concerns.
- −Residency verification for people without documents is administratively and politically fraught.
- Easy enrollment vs. program integrity: presumptive eligibility at the point of care means some non-residents will receive care. The plan accepts that cost (small) to guarantee no eligible person is turned away.
Trade-off behind each cost item
- Mostly Year 1 (largest wave), then one notice cycle per later wave.
Trade-off behind each system change
- Annual open enrollment and plan selectionNo paperwork; no plan choice.
- UHP number and card (new)Simplicity; privacy concerns about a universal identifier.
- Health care in jails and prisons (Medicaid inmate exclusion)Reduces overdose deaths and readmissions after release; corrections systems still fund in-custody care.