Tuesday, December 22, 2020

At pandemic's peak, Medicaid expansion enrollment is keeping pace

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Deep into fall and a resurgent pandemic, Medicaid enrollment growth among those rendered eligible by the ACA expansion (adults with incomes up to 138% FPL, or $1,468/month for an individual) shows no sign of abating. 

In the 18-state sample below, representing about 36% of the "expansion" population in the 37 states (including D.C.) that have have enacted the ACA expansion thus far, enrollment in this category increased 22.1% from February through October. In fourteen states that have reported through November, enrollment is up 24.7% since October. Month-to-month, enrollment increased 2.2% from September to October (18 states) and 2.3% October to November (14 states). 

Pandemic Medicaid Expansion Enrollment in 18 States
February through November

Expansion enrollment since February is up 39-49% in three states -- Maine, Utah and Idaho -- that enacted the expansion recently. Maine's expansion launched in January 2019, and Utah and Idaho's in January 2020 (Utah had enacted partial expansion to 100% FPL as of April 2019). Nebraska opened the expansion gates this past October; I don't believe the state has yet published enrollment numbers. Oklahoma and Missouri are scheduled to launch expansions on July 1, 2021. In all five of these states, expansion was mandated by referendum, and Republican officials dragged their feet.

Nationally, relatively slow growth in California (a bit less than half the national growth rate) probably reduces the all-state growth rate by about 2.5 percentage points. (California is a behemoth, home to about a quarter of expansion enrollees.) My estimate, based on monthly state reports is that nationally, the expansion population increased 22.2% from February to November. That would peg the current expansion enrollment population at about 18.7 million, up from 15.3 million at last official count (July 2019).

According to CMS, 78% of the "expansion" population -- those for whom the federal government pays states the "enhanced match" rate of 90% of costs -- was rendered "newly eligible" by the ACA. Those not made "newly eligible" by the ACA are in states that extended Medicaid eligibility to adults with incomes up to at least 100% FPL prior to ACA enactment. The "newly eligible" population likely now stands at 14.6 million, up from 12.0 million in mid-2019. 

Enrollment in the ACA private-plan marketplace is likely a bit shy of a million higher than it would have been were there no pandemic (see this post with regard to 2020 off-season enrollment, and this for what we know so far about 2021 enrollment). In total, then, enrollment directly enabled by the ACA has probably surged by about 3-4 million in response to the pandemic. About 23-24 million people are in coverage subsidized as a direct result of the ACA (14 million-plus in Medicaid, 9-10 million subsidized in ACA marketplace). Total Medicaid enrollment is up by 7 million-plus, according to state reports.

Medicaid enrollment growth since the pandemic triggered mass job loss has been boosted by a pause in state "redeterminations" and disenrollments mandated by the Families First Act, enacted March 18. Enrollment growth in the expansion population has been roughly double that of total enrollment in all Medicaid categories.

For more context about expansion enrollment, and my sources and assumptions in tallying it, see this post.

As Colorado alone among these states has not yet reported for October, I estimated CO growth for the month at 2%. Enrollment in the state was up 2.3% from August to September. Any error in that (green-shaded) estimate would have a minimal effect on 18-state totals.

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