Monday, July 13, 2020

Medicaid enrollment in a pandemic: 18-state snapshot (expansion only)

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Update, 8/14: for all further updates please see the 26-state snapshot published August 12.

Update, 8/5/20:  Enrollment in Utah, which enacted full Medicaid expansion in Jan. 2020 following a partial expansion (for adults up to 100% FPL) launched in April 2019, increased 10.9% from February to June 2020. The population of enrollees rendered eligible by the expansion is up 25.5% in the same period. As the unemployed population in Utah was 45,000 higher in June than in February (largely recovered after a huge spike in April), the increase in Medicaid enrollees in the state since February (33,615) may exceed the increase in newly uninsured. 

Update, 8/4/20: Minnesota managed Medicaid/MinnesotaCare enrollment increased 1.5% July-August. It's now up 14.% since February. New York is up 9.5%, Feb-July; New Jersey is up 7.0% in the same period. Medicaid expansion population totals for Maine and Virginia are also update. 

Update, 8/2/20: I have updated the chart with July and/or June tallies for Illinois, Maryland, Oregon, and Washington. Noteworthy: a 3.1% surge in Illinois in June, and an Oregon update through July 27 that shows total enrollment up up 9.1% since February 3. Overall, enrollment in Medicaid programs charted by these 16 states (e.g., all Medicaid, managed Medicaid only, or ACA Medicaid expansion population only) was up 6.8% February through June. Colorado, newly added, was up 7.0%, Feb-June.

As mass unemployment appeared almost instantly in the wake of the pandemic-triggered shutdowns in March, and is likely to persist as the U.S. fails to contain the virus, I have focused almost all posts in recent weeks on increases in Medicaid enrollment in states that have enacted the ACA Medicaid expansion.

To repeat a baseline expectation, the Urban Institute forecast that if 15% unemployment lasts for "several months to a year," between 8.2 million and 14.3 million people would enroll in Medicaid, an increase of 11%--20% over total enrollment in early 2020, or 16%--28% over the total of enrollees under age 65.   While the current national unemployment rate has dipped officially to 11% (actually 12% when a categorization error acknowledged by BLS is added in), it's likely to spike again as our public health failures lead to renewed shutdowns and our legislative failures result in cutoffs or sharp reductions in relief benefits.

In Kentucky and Minnesota, Medicaid enrollment has already increased by double digits since February. In others, it's barely budged.  Myriad factors determine the rate of growth, including the extent of job losses in the state, the types of jobs lost, the mode/duration of layoff, and state per capita income.

I am more focused on factors within the states' control -- whether there is any effective outreach to inform the newly unemployed of their health insurance options and prompt them to apply -- for Medicaid (primarily) or marketplace insurance as appropriate.  Outreach can come via state-based ACA marketplaces (there are just 13; the federally administered serves the rest), advertising, governors' pandemic briefings, the state taxing authority (as in Maryland) or -- most promisingly, through the unemployment insurance division of state labor departments, as urged by Families USA and the Brookings Institute. As far as I know, Kentucky, where Medicaid enrollment is up 14%, is the only state that's fully exploiting this vital channel. Expanding presumptive eligibility (which Kentucky has also done) or accepting attestation of income can also have a strong impact.
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I hope to be able to report further on select state actions -- and possible state actions not yet implemented anywhere -- in coming days. Meanwhile, here is the enrollment data I have on expansion states that have reported enrollment as of May. As indicated, some states report on all Medicaid enrollment, some on managed Medicaid only (in NY, that's about two thirds of all enrollment; in Minnesota, it's about 80%), and some (Maine, Montana, Virginia) on "expansion" enrollment only -- that is, those rendered eligible by the ACA's expansion of eligibility to most people in households with income up to 138% FPL.

In prior posts, I've looked at factors affecting enrollment in Kentucky, Minnesota, New York (1, 2), and Maine. More to come.

Pandemic Medicaid enrollment
Updated Aug. 5, 2020
Update, 7/25/20: Indiana enrollment rose 2% in June and is up 10% Feb-June. Virginia, which enacted the ACA Medicaid expansion in 2019, tracks expansion enrollment; it's up 10% from April through July 15 (the dashboard doesn't go back further than 4/1). Chart updated.

P.S. These links  go to the pages I've been monitoring:
New Hampshire
New Jersey
New Mexico 
New York
Utah  no link  

The Utah data is from the state Dept. of Health but was sent to me by a state healthcare advocate -- I cannot find it online.

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