Saturday, January 30, 2021

Estimate: ACA Medicaid expansion enrollment may have grown 25% from February to December 2020

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As Covid-19 burned its swath through the U.S. in December, Medicaid enrollment in the ACA expansion category (adults with monthly incomes up to 138% of the Federal Poverty Level) continued the rapid growth that started with the pandemic.

Enrolment increased 2.7% from November in the 17 states for which I've been able to locate monthly expansion-category enrollment reported through December. In those 17 states, enrollment increased 27.6% from February 2020 -- the last month in which the economy was unaffected by the pandemic -- through December.

    Expansion Medicaid enrollment in select states
     February through November/December 2020

Medicaid expansion enrollment 2020

Nationally (as noted in my last expansion enrollment update), relatively slow growth in California (where the overall Medicaid growth rate has been bit less than half the national rate) probably reduces the all-state growth rate by about 2.5 percentage points. (California is home to about a quarter of the nation's expansion enrollees.) To the extend this sample is representative* (it accounts for about a third of expansion enrollment), the enrolled expansion population may have increased by about 25% from February through December, from 15.3 million to 19.1 million.

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 just about 15 million, up from 12 million.

If these estimates are on target, enrollment growth in the ACA expansion category probably accounts for more than 40% of total Medicaid enrollment growth from February through December 2020, and the expansion category now accounts more nearly a quarter (about 24%) of total Medicaid enrollment.

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

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* Enrollment growth rates in the 33-state sample I've been following for total Medicaid enrollment do match the 50-state total as recorded by CMS. This sample of course may be less representative.

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