Millions of eligible (low-income) adults are not enrolled in Medicaid.  This study provides evidence that, whether or not they implement the expansion permitted under the Affordable Care Act (ACA), states can improve take-up by vulnerable working age adults by seeking authority from the Centers for Medicare & Medicaid Services (CMS) to designate unemployment insurance offices "as express lane agencies."

Utilizing a cross-section of changes design, I estimated, using ordinary least squares regression, whether unemployment leads to Medicaid enrollment when controlling for state economic, demographic, and program characteristics (for example, eligibility standards and processes).  I obtained state enrollment data from CMS' Medicaid Statistical Information System (MSIS) and program and economic data for the same period, one that saw the largest increase in unemployment rates since the Great Depression, from the Kaiser Commission on Medicaid and the Uninsured, the Bureau of Labor Statistics (BLS), and the U.S. Census Bureau’s Current Population Survey (CPS).  Medicaid enrollment increased significantly in states that covered "childless" adults. In addition, increased unemployment led to at least marginally significant increases in Medicaid enrollment in other states and eligibility groups. 

Congress has permitted states to rely on findings from certain state agencies (known as "express lane agencies"), such as the agency determining eligibility for the Supplemental Nutrition Assistance Program (SNAP), to conduct simplified eligibility determinations to facilitate children's enrollment in Medicaid and CHIP.  CMS has extended section 1115 waiver authority to states to extend express lane eligibility to adults.  No state has designated state unemployment offices as express lane agencies.  This study provides support for changing federal law or state decisions.