Monday, January 25, 2021

Medicaid enrollment likely near 80 million in December

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I am pretty confident that total Medicaid enrollment, which stood at 71.2 million in February 2020 according to CMS's adjusted total, is now in the neighborhood of 80 million.*

CMS's official tally through September shows a 9.4% increase from February. My tally below, based on monthly enrollment reports in 33 states, shows a 9.7% increase from February through September, 11.8% through November, and a likely further 1% increase in December (California will as usual drag the all-state percentage increase down a bit). A 12.4% increase from February through December would suggest 80 million total enrollees -- pretty close to a quarter of the U.S. population.

Enrollment will likely continue to increase as long as the federal emergency triggered by the pandemic remains in effect, as the pause in disenrollments mandated by the Families First Act (for states that want to continue to receive the enhanced federal match, as all have opted to do) will last for the duration. Rain keeps dropping into the lake, but there's very little evaporation.

For more context (including a link to more info about my methodology), see this post.

    Medicaid enrollment in 33 states, February to November/December, 2020

Pandemic Medicaid enrollment thru Dec. 2020

States in blue ink have enacted the ACA Medicaid expansion; states in red ink have note. Wisconsin, which grants eligibility to adults with incomes up to 100% of the Federal Poverty Level (as opposed to to 138% FPL in ACA expansion states), is in purple.

Numbers in green are estimated: Illinois, at a 1% per month increase (reflecting the Aug-Sept. increase as well as the rough national average), and Kentucky, as flat, since after leading the country through October the state recorded a drop in November.

One data note: between my last tally and this one, I stumbled on a monthly report for New York that tallies total Medicaid enrollment, as opposed to just Medicaid managed care (approximately 2/3 of the whole), which I had been relying on previously. As in other states, enrollment in fee-for-service Medicaid grows slowly or not at all, so the rate of increased in the managed care tally is higher. That is doubtless true in Minnesota and Michigan, the remaining states in my sample for which I have only the managed Medicaid report.

Update, 1/26/21: Illinois posted a large increase (3%) in October, enough to boost the national increase by a tenth of a percentage point. The chart is updated.

* I have corrected the estimates here, as I originally in error pegged  CMS's February 2020 total at 72 million. I therefore estimated the December total as "likely" over 80 million, whereas CMS's December total, once finalized will likely hover right around 80 million. We'll find out soon enough.


  1. So, 80 million people get their health insurance from Medicaid: traditional and expanded.

    That's about 25% of the people in the country.

    Once you know about the issue that this "coverage" is often not "insurance" but rather just a loan for medical expenses

    (as here: or the Wikipedia article on Medicaid estate recovery),

    you can't unsee it, and can't stop thinking: those people are in at least 12 states (including blue MA, MD, and NJ) being treated second class, like they have no right to pass on assets, and any medical bills that come in for them will be paid only temporarily, and to be estate recovered at death. (It can be all bills that came in--that's not insurance at all.)

    A further thing: it may not be limited to just those roughly 12 states that estate recovery now for ordinary medical (non-long-term-care) Medicaid and expanded Medicaid.

    The right of retroactive change in estate recovery policy may vary state by state in the other 38, but Minnesota, which, after public outrage, stopped the estate recovery on non-long-term-care Medicaids in about 2017, still seems to maintain the option to retroactively recover CURRENT AND PRIOR of these Medicaids. So, despite the recovery policy change, it may be only temporary and retroactively alterable. And the people now still, right now, have no insurance! (It may turn out they had just a loan!)

    For Minnesota, I have knowledge that a person in the state was told by the state estate recovery department that the state maintains the option of retroactively deciding to estate recover current and prior expanded and traditional Medicaids.

    It's also consistent with the current MN ACA form:

    "If anyone on this application is eligible for Medical Assistance, I have read and understand that the state may claim repayment for the cost of medical care, or the cost of the premiums paid for care, from my estate or my spouse’s estate."

    (adobe p. 21)

    (Later on in the application, it says,

    "If you are enrolled in MA when you are 55 years old or older,
    after you die, Minnesota must try to recover certain
    payments the MA program made for your health care,
    • Nursing home services
    • Home and community-based services
    • Related hospital and prescription drug costs"

    only referencing the recovery of long-term-care, etc., but NOT saying they won't recover standard medical Medicaids and expanded Medicaid.

    In fact, to find that current estate recovery policy, I had to go elsewhere: .)

    So, for all we know, and if the other 37 states (besides the 12 that now do the estate recovery and MN) are like MN, with a retroactively-alterable no-recovery-on-expanded-Medicaid-now policy, we have 25% of the country treated assets-don't matter--you get no insurance--just a loan--when you are 55-64. Jeesh.

    The don't do this kind of just-a-loan thing in the rest of the developed world, as far as I can tell.

  2. The rationale for estate recovery is this:

    You can receive Medicaid without counting your house as an asset.

    If you own a house free and clear, then technically you are not poor.

    Medicaid is meant for the poor. Estate recovery enables the program to help more poor people.

    I think that to defeat estate recovery, we need to challenge this logic. Thanks for all your efforts on this.