Friday, July 03, 2020

Where is Medicaid enrollment surging? A June update

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7/9/20 -- see updates at bottom re strong July enrollment growth in Minnesota and Kentucky

A month ago, I spotlit a handful of states in which Medicaid enrollment was surging in response to the mass job losses triggered by the Covid-19 pandemic. Here, an update.

To review the context for enrollment growth recorded so far: the Urban Institute has 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.  Joan Aiker and Tricia Brooks of Georgetown have tracked enrollment in 22 states that have reported through May and found an average increase of 5% over February.

Notes below track enrollment logged in June or as of July 1.  While the Georgetown scholars are tracking both expansion and nonexpansion states, I've limited myself to expansion states where growth is particularly strong.

As of the end of May, both Kentucky and Minnesota had reported increases exceeding 10% since February. I don't have an update yet for either. Among states with new data:

  • Enrollment in New York's mainstream managed Medicaid programs (representing about 2/3 of total Medicaid enrollment)  surged 3.1% in June after a 2.6% increase in May. Enrollment is now up 7.5% since February to 4.36 million.  An emergency Special Enrollment Period in New York's ACA marketplace, New York State of Health, extended to July 15, may be helping (about half of total Medicaid enrollment in the state comes through the exchange).** As I noted recently, the SEP has enabled to NYSOH to broadcast an unconditional "come one, come all" message to all the state's uninsured. Thanks to the state's Essential Plan, a Medicaid-like program available at incomes up to 200% FPL to those who don't qualify for Medicaid, a large majority of those who visit the site can likely find either free or very low-cost coverage.

  • Indiana enrollment jumped 2.7% in May, lifting it 7.4% above the February total, from 1.32 million to 1.42 million.

  • Maine tracks enrollment of the Medicaid expansion population specifically, and it's been skyrocketing, up 21.2% from February to June, from 44,000 to 55,000. Momentum continued in June, with enrollment up 4.4% from the month prior. See the prior post for speculation as to the causes of the surge from Mitchell Stein, a Maine health policy consultant.

  • New Hampshire enrollment jumped 6.1% March to May, from 179,510 to 190,988.

  • Arizona enrollment is up 7.0% from March 1 to July 1, with growth slowing a bit from monthly increases of 2-3% from March through June to 1.2% this past month.
Kentucky and Minnesota will likely report new totals immediately after the holiday; I will update then. Also, I believe that New Mexico has had a recent surge, but the report for the current month is in different format from reports for months past, so I have some checking to do.

Some further context from prior posts: so far, losses of health insurance reported in national surveys are more modest than one might expect, and Medicaid enrollment is likely to lag filings for unemployment insurance by some months. When people are laid off, insurance is usually not the first thing they think of or deal with.

UPDATE, 7/6/20: Minnesota just reported a 1.6% from June to July and now leads the league among reporting expansion states with a 12.8% increase since February in managed care Medicaid enrollments, from 912,534 to 1,029,405 (re prior posts, each month's update also updates prior month totals). That count includes enrollment in MinnesotaCare, the state's Basic Health Program, like New York's a Medicaid-like program for people with incomes up to 200% FPL who don't qualify for Medicaid. MinnesotaCare enrollment has leapt 22.5% since February, from 67,978 to 87,756. The increase is concentrated among childless adults, up 36.3% Feb-July, from 36,825 to 57,831.  MNSure, the state ACA exchange held an emergency Special Enrollment Period for the marketplace from March 23 thru April 21, From March to May, childless adult enrollment in MinnesotaCare rose 24.3%. Monthly figures in Minnesota are logged at the beginning of each month, so April and May counts encompass the SEP. As I noted in my earlier post about growth in Minnesota, though, MinnesotaCare enrollment also increased sharply in early 2019 -- 17.9%  from February through July -- so a seasonal pattern may be at work there.

UPDATE 2, 7/9/20: Kentucky's July enrollment by county is out, and it's jumped 3.6% since June, from 1,451,854 to 1,503,954. That's up 14.4% since February -- the strong increase among the expansion states that I've been able to track.

For more about Kentucky's proactive outreach to the newly unemployed, easy (temporary) presumptive eligibility enrollment and other means of drawing in the uninsured, see this post.

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* While the unemployment rate dropped sharply this month, to about 12% (factoring in a misclassification error acknowledged by BLS), the gains preceded renewed closures forced by the surging pandemic.

**NYSOH announced in February that 3.4 million New Yorkers enrolled in Medicaid through the exchange during Open Enrollment for 2020.  As of March 2020, total Medicaid enrollment in New York was 6.1 million.

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