At the New Year, pause to celebrate Medicaid

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Let's ring out 2020 with a final tracking of Medicaid enrollment during the pandemic.

In this 33-state sample, based on state monthly reports, Medicaid enrollment increased 11.1% from February through October, and an estimated 12.1%* from February through November. 

Since the increase reported in CMS's official tallies, currently running through a preliminary August report, generally show about a half percentage point slower growth** than my more up-to-date tally (8.3% vs. 8.8% for August), I imagine that CMS will show an increase of about 11.6%, February through November. That would mean 79.4 million people enrolled through November, an increase of about 8.25 million since February. [Update, 4/5/21: CMS's preliminary November total does indeed show an increase of 11.6% since February.]

Medicaid enrollment in 33 states, February through November 2020

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In a time of government dysfunction, in a country that's grudging in benefit delivery, Medicaid's response to the job loss and demand for access to medical care triggered by the pandemic is something to celebrate. Consider:

• The Families First Coronavirus Response Act, passed on March 18, required states to pause redeterminations and disenrollments for the duration of the national emergency as a condition of receiving a 6 percentage point increase in the federal government's share of state Medicaid funding. That pause is a major factor in enrollment growth. While the FMAP increase is inadequate to states' needs, and Republicans blocked further increases, the enrollment pause did yeoman's work in keeping people insured. 
  
  
• Five states have belatedly enacted the ACA Medicaid expansion since 2019, with two more scheduled to enact in July 2021. Grass roots demand forced six of those seven expansion via referendum. In the four states that had expanded between January 2019 and January 2020 (Idaho, Maine, Utah and Virginia), 710,000 people enrolled via expansion criteria, and "expansion" enrollment increased by 30% from February through October. Nationally, enrollment in the ACA expansion category has increased by over 20% to about 18.5 million since February.

• In 2019, federal courts mostly killed the Medicaid work requirements encouraged by the Trump administration, and the pandemic emergency put on the final kibosh, at least until the next Republican administration.
  
  
• In response to the emergency, many states expanded presumptive eligibility, accepted self-attestation of income for people in various enrollment categories, loosened requirements for some eligibility categories, and took other steps to expedite and expand enrollment.

There's bad news too, of course. Trump's CMS is taking last-minute steps to enable states to end-run the pause in disenrollments and gum up Medicaid administration generally by requiring periodic reassessment of all regulations (the comment period for this one ends in 4 days).

Put that 11th-hour rulemaking on the pile of headaches for the incoming Biden administration. The need for more state aid -- in Medicaid and generally -- remains desperate. But broadly speaking, at a time of crisis, the Medicaid program held up, and responded to need. Happy New Year!

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* Comparatively slow growth in California, for which a reliable November tally is not yet available, will reduce the November growth rate. The 12.1% Feb-Nov growth estimate above assumes that growth in the states that have not yet posted November totals will continue at the previous month's rate. For Illinois, with its long lag, I have estimated 1% growth per month in September and October.

** For a discussion of the difference between CMS tallies and more-up-to-date tallies based on state monthly reports, see this post.

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