The Woodwork Effect

In health policy terms, the “woodwork effect” describes the increase in enrollment that can occur after programs are expanded or changed, encouraging eligible participants to “come out of the woodwork” to enroll in them. For home-based care programs, this enrollment increase can lead to increased costs if the expense of treating more participants outweighs the cost savings from avoiding or delaying institutional care.1 The extent of the woodwork effect and its true risks are the subject of considerable debate. Some policymakers and budget officials believe that the woodwork effect’s increased costs are unacceptable, whereas others believe that these costs are ethically justified by the increased number of people who receive needed services in their homes and communities. Because “woodwork effect” has a negative connotation, some researchers and advocates prefer to call it the “welcome-mat effect,” which more positively conveys the process of providing a program’s services to eligible individuals who were not previously enrolled.2

1. Mitchell LaPlante. 2013. “The Woodwork Effect in Medicaid Long-Term Services and Supports,” Journal of Aging & Social Policy, 25:2, 161–80.
2. Julie Sonier, Michel H Boudreaux, and Lynn A. Blewett. 2013. “Medicaid ‘Welcome-Mat’ Effect of Affordable Care Act Implementation Could Be Substantial,” Health Affairs 32:6, 1319–25.