Where is Medicaid enrollment surging? Notes from a few states

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Last month, the Urban Institute forecast that at 15% unemployment, between 8.2 million and 14.3 million people would enroll in Medicaid, an increase of 11-20%.* While the job rate officially now stands at 13.3%, it would be 3 points higher if those classified as employed but absent from work were counted as unemployed, as BLS says they should be (see pg. 6 here).

I have been tracking Medicaid enrollment in states that have accepted the ACA Medicaid expansion and that report timely monthly data. As of early May, enrollment in Kentucky and Minnesota was the highest I was able to track, having increased about 8% since February.  Nationally, the increase at that point was probably about half that. In both states, enrollment increased by another 2% from May to June.

Below, a few bulletins from states (including MN and KY) showing significant enrollment growth. A 2% jump in a given month seems like a frequent marker that enrollment is getting in gear.

• In Minnesota, enrollment in managed Medicaid programs and MinnesotaCare (a Medicaid-like program for people with incomes in the 139-2005 FPL range) increased another 2% from May to June, from 990,000 to 1.01 million. It's up 11% since February. In 2019, enrollment from February to June rose 2%. The state unemployment rate in April was 8.1%, well below the national 14.7% rate.  From March 23 to April 21 the state's ACA exchange, MNSure, ran an emergency Special Enrollment Period under which anyone who was uninsured could seek coverage. Although Medicaid enrollment is year-round, the open invitation to seek available coverage may have had a stimulating effect.**


• Kentucky also recorded a 2% increase from May to June and is up 10% since February, from 1.32 million to 1.45 million. Governor Andy Beshear's administration may be doing the most energetic outreach in the country. The state unemployment insurance agency is sending UI enrollment information to the Dept. of Medicaid Services, which is emailing and snail-mailing the newly unemployed to encourage them to enroll in health coverage. If a  recipient opens the email and does not complete an application as prompted, a second email promises that an HFS employee will phone with an offer of help. About 20% of new enrollees have enrolled through a short-form application providing two months of emergency presumptive eligibility. As of April, the state unemployment rate was 15.4%


• New York, which reports later in the month than MN and KY, recorded a surge in its May tally of mainstream managed care Medicaid enrollment, up 2.6% over April and 4% over March, from 4,186,015 to 4,363,873.  The unemployment rate in New York was 14.5% in April.


• Enrollment in Arizona jumped 2% from May to June and is up 6% since February, from 1,876 million to 1.99 million. Unemployment in April was 12.6%


• Maine, which enacted the ACA Medicaid expansion in early 2019, tracks enrollment of the expansion population (adults with incomes up to 138% of the Federal Poverty Level, not eligible by prior criteria). That's the population likeliest to swell as people lose jobs. It's jumped 20% from February to June, from 44,000 to 55,000.  Mitchell Stein, a Maine-based healthcare policy consutlant,  notes that the state has a lot of low-wage workers in the hospitality industry and says that the state is doing a lot of outreach. I'd add that Maine's HHS website does an admirable job displaying the eligibility thresholds -- simple information that's often hard to come by on government websites. Stein cautions that enrollment prior to the crisis was below expectations.  Unemployment was at 10.6% in April.

See past posts about ways to boost enrollment: 1) recruit state unemployment insurance agencies, 2) raise Medicaid's profile on ACA exchanges. 

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* A Kaiser Family Foundation analysis suggests somewhat higher potential enrollment. Prior to today's jobs report finding an increase of 2.5 million employed, nearly 41 million Americans had filed for unemployment benefits since mid-March. Kaiser's May estimate, based on 31 million new jobless claims, was that nearly 27 million people would lose job-based insurance. That suggests about 33 million newly uninsured people as of now. Also by Kaiser's estimate, just shy of half of them -- say 16 million -- should be eligible for Medicaid. If all who were eligible enrolled, that would constitute about a 22% increase in total Medicaid enrollment.

**  As state-based marketplaces are not dependent on the federal government for enrollment assistance funding, which the Trump administration gutted in the 38 states using HealthCare.gov Minnesota may also benefit from an intact enrollment assistance infrastructure. The department said in a statement that "in multiple media interviews related to the pandemic, DHS officials have encouraged individuals who have lost their jobs or commercial insurance coverage to get help from a navigator, their clinic, their county or tribal nation, or our department to determine whether they qualify for one of our programs."