Wednesday, August 12, 2020

Medicaid enrollment in a pandemic: 26-state snapshot

Subscribe to xpostfactoid

Update through 9/2 here

Update, 8/19: See this post for a somewhat cleaner comparison through July, reconciling states' different schedules for tallying and methods of labeling a given month.

Update, 8/15: Illinois Medicaid enrollment surged 6.4% from June to July and is up almost 10% since May. Enrollment in Indiana is up 11.8% since February. Of the twelve expansion states below that have reported enrollment in all or most Medicaid programs through July (excluding tallies for expansion population only), the average increase since February is 9.2%. 
It's time for a fresh post on pandemic Medicaid enrollment, instead of piling updates on my prior snapshot. While I'm focused primarily on states that enacted the ACA Medicaid expansion, I've started to also track nonexpansion states and will keep adding them as I find data.  I have a bunch of URLs to pick through, thanks to a very helpful overview of enrollment in 33 states through May and June  by Chris Frenier, Sayeh S. Nikpay, and Ezra Golberstein.

To review some basic context: the Urban Institute forecast that nationally just shy of half* of those who lose access to employer-sponsored insurance will enroll in Medicaid if severe unemployment lasts for "several months to a year." At 15% unemployment, Urban projects that between 8.2 million and 14.3 million people will 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 10%, 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.

Note that some of the the tallies below are for the ACA Medicaid expansion only -- that is, adults with incomes under 138% of the Federal Poverty Level. The federal government pays 90% of the cost for enrollees rendered eligible by the expansion. It's not surprising that the expansion population tallies reflect faster growth, since a large percentage of the nation's children were enrolled in Medicaid or CHIP pre-pandemic, enrollees over age 65 are in Medicare and usually not reliant on employer-sponsored insurance, and those eligible for disability Medicaid are also likelier to have been enrolled pre-pandemic.

       Medicaid enrollment in 26 states, February - August 2020
Medicaid enrollment in the Covid-19 pandemic

Subscribe to xpostfactoid

As the chart shows, Medicaid enrollment growth since February is already in double digits in many states.   (I say "already" in light of research indicating that in the last major recession, peak Medicaid enrollment lagged peak unemployment by seven months, albeit in a time and place where Medicaid enrollment was harder than now).

Much of the increase in Medicaid enrollment is attributable to the Family First Act's stipulation that states seeking to access the enhanced federal match rate for their Medicaid bills provided in that bill as emergency relief (i.e., all states) would have to refrain from disenrolling beneficiaries for the duration of the emergency. In May, New Jersey attributed a 5% enrollment increase since March all but entirely to pausing redeterminations and disenrollments. But by now the gains in many states far exceed that reduction in churn.

A few highlights not noted in past updates:
  • Expansion enrollment in Maine, Utah, Michigan, Alaska, Virginia and Louisiana has, um, expanded -- serving a core ACA function as a crisis-time safety net. In Montana, not so much, though enrollment picked up a bit June-July. 

  • Totals for Alaska and Utah, two states where I've found monthly tallies both for all Medicaid and for the expansion population, illustrate different degrees to which the expansion population is driving current enrollment growth. In Alaska, the expansion population is 24% of total Medicaid enrollment, but accounts for 62% of Medicaid enrollment growth since February. In Utah, expansion represents 15% of total enrollment and 36% of enrollment growth since February.

  • Michigan's expansion population (newly added here) is up 15% since February and 8.9% since May.

  • In Minnesota, the increase since February in managed Medicaid enrollment (including enrollment in MinnesotaCare, a Medicaid-like program for residents with incomes up to 200% FPL) reached 14.5% in August. 

  • Wisconsin enrollment among children and nonelderly adults (excluding the disabled) increased 13.2% from February to July. While Wisconsin is not an expansion state, residents with incomes up to 100% FPL (as opposed to 138% FPL in expansion states) are eligible. Since subsidized ACA marketplace insurance eligibility begins at 100% FPL in nonexpansion states, subsidized coverage of some sort is thus available to all legally present Wisconsin residents with incomes up to 400% FPL who lack access to employer-sponsored insurance.

  • Florida enrollment was up 9.8% February -- June.
See posts below for conditions contributing to enrollment in:
New York
Maine (also NY, KY, MN)

Finally, these links  go to the state enrollment reports I've been monitoring:
New Hampshire
New Jersey
New Mexico 
New York
North Carolina
Utah  no link  
West Virginia

Alaska and Michigan provide current enrollment snapshots. In Alaska, I couldn't find other data; in Michigan, these snapshots are more up-to-date and comprehensive than historic charts. In both cases, I used the Wayback Machine to get prior months.----

*Urban forecasts that in Medicaid expansion states, about 54% in expansion states of those who lose access to ESI will enroll in Medicaid.

Updated with Alaska info, 3:30 p.m, and with Texas and West Virginia, 6:00 p.m.

Subscribe to xpostfactoid

No comments:

Post a Comment