Saturday, December 12, 2020

As long as no one is thrown off Medicaid, will enrollment keep growing by 1% per month?

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I am beginning to wonder. I gather that no one has a precise idea what percentage of Medicaid enrollees are disenrolled every month by state income checks and eligibility redeterminations. The Families First Act paused those disenrollments for the duration of the national emergency -- as of now, through the end of March -- though a new interim final rule issued by Seema Verma's CMS appears to give states a green light to deem some past enrollments "invalid" and void them.

Of course, people continue to disenroll from Medicaid -- when they get a job with affordable insurance, or marry someone with insurance, or move, or age into Medicare (at which point the income thresholds for Medicaid drop in most states), or age out of CHIP, or die...etc. etc. It also seems clear that with 5 million more unemployed in November than in February, despite a snap-back from 14 million newly unemployed at the May peak, demand for Medicaid has grown.

At the same time, the Kaiser Family Foundation recently found that the ranks of those insured through employers have decreased only modestly (-1.5%) in the pandemic. Medicaid enrollment, meanwhile, has continued to grow by 1% per month or more in recent months -- at least by my compilation of state monthly enrollment reports, which shows somewhat more growth that CMS's time-lagged official monthly tally.* Certainly a significant portion, and possibly a very large portion of the enrollment growth is a result of the pause in disenrollments.

Below is an update to my 32-state tally through October. California has updated its numbers, with modest changes from February through September (the state considers tallies final after 12 months). I should arguably take Illinois out of the sample, as it's now lagging severely, but I don't think my estimates (in green) are likely to change all-state totals much.

    Medicaid enrollment in 32 states, February-October 2020 

    Sources: State monthly Medicaid reports (see this post, at bottom).
     Medicaid expansion states in blue; nonexpansion states in red; quasi-expansion in purple

The growth rates recorded here suggest that national Medicaid/CHIP enrollment has reached 79 million. When CMS tallies reach October, perhaps they'll show total enrollment at around 78 million.


CMS Medicaid tallies differ somewhat from state reports in the programs they cover. The table in this post includes the percentage of CMS total reflected in each state-published total.

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1 comment:

  1. My own obsession with the issue of estate recovery on ACA expanded Medicaid and other non-long-term-care Medicaids for people 55+ in 10-14 states (including blue MA, NJ, and MD) forces me to point out that in many cases, return to normal on-exchange ACA plans would take away a financial bomb for some people's children ("insurance" in the Census Stats, but really only a loan until death for medical expenses with no insurance at all.)

    (On-exchange ACA insurance is not subject to estate recovery.)

    My first reference, for those unfamiliar, will be your own xpostfactoid mention of the matter last year.

    The second is the Wikipedia article on Medicaid estate recovery, which I actually wrote most of last year after finding out about the problem. (Everything can be verified for the references there, which are all online.)


    2014 W Post Article:

    The Atlantic in 2014:

    Seattle Times (late 2013):

    Which actually led, in just a few days, to Washington State fixing, as here:

    MN corrected in 2017


    Michelle Singletary, the W. Post household-finance columnist bumped into it in MD recently.

    Scroll to "Q: Medicaid estate recovery".

    (Note this was an estate recovery of all medical bills for ACA expanded Medicaid.)


    Aah: Something new: Someone indicated to me that there might actually be a bill coming up to stop the estate recovery on expanded Medicaid which is being started in the US House by an Iowa Republican:

    However, there is no text yet, so who knows?

    Obviously, even though the source is Republican, and we know about Republicans and health insurance, if the bill does stop estate recovery on expanded Medicaid it is a correct action, moving the U.S. an important bit closer to what the rest of the world has--affordable universal coverage.

    (A reason such a bill could come from the Republican side is that the estate Recovery is sometimes framed as a government seizure, causing a reaction from the right. Sometimes from the same people who oppose the ACA as "socialism". Nonetheless, we can't afford to be too picky on matters of what the people understand, and those of us who want universal affordable coverage should support it if it turns out to be what it looks like.)

    Just from the title, which is up, it is limited to "certain expansion individuals", so at most it would cover expanded Medicaid, and not other non-long-term-care Medicaids, which really should be included to get us towards real universal affordable coverage.