Monday, February 22, 2021

Medicaid enrollment likely reaches 81 million in January

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Chart updated 3/3/21

This is an update to my recent post estimating total national Medicaid enrollment at upwards of 80 million through December, up from 71.2 million in February 2020, the last month before the pandemic struck the economy.

I've added December updates from four states -- including the big one, California -- to the sample, as well as adding Nebraska, which enacted the ACA Medicaid expansion beginning in October. As I forecast, continued relatively slow growth in California drops the full-sample rate of increase by about two and a half percentage points.  

As always, the official CMS tally for all states, currently stuck in September, is likely to show a somewhat smaller increase than my sample. For September, my sample showed an increase of 9.7% over February, while CMS currently shows a 9.4% increase in the same period.  Conservatively, then, I'll posit that CMS will show a 12.5% increase from February through December 2020, which would put national enrollment at 80.1 million.  (The sample consists of states for which I can find monthly enrollment reports.)[Update, 4/5/21: CMS's preliminary November total shows an increase of 11.6% since February, as I forecast on New  Year's Eve, compared to the 12.0% increase for the same period charted in my sample below.*]

January appears to be have held steady with another 1%-plus monthly increase, likely putting total enrollment over 81 million at present. Again, the pause in monthly income redeterminations and disenrollments effectively mandated by the Families First Act last March may drive continued monthly increases in the one percent range until the moratorium ends with the national emergency. The rain continues, but evaporation is minimal.

Click to enlarge the ridiculously small image below. As always, Medicaid expansion states in blue, nonexpansion states in red, quasi-expanded Wisconsin in purple.

    Medicaid enrollment in 34 states, February to December, 2020

Pandemic Medicaid enrollment growth

December totals for three states are estimated, with estimates marked in green: Utah, where enrollment is too small for any error to much affect national totals; Illinois, which has seen rapid growth in recent months, and which I estimated conservatively at 1% growth for December; and Kentucky, which seems to have skipped a month's reporting, leading me to simply split the difference between November and January for the December total.

Enrollment growth in the ACA expansion category is about twice the overall Medicaid growth rate. Medicaid expansion is the ACA's workhouse.  

P.S. A reminder: when a state reports its monthly totals as of the first of the month, or during the named month, I backdate them, so that the "March" report becomes "Thru Feb" above. 


*  Since each month's final tally is typically several hundred thousand above the preliminary total, CMS compares preliminary-to-preliminary monthly totals. The preliminary total for February 2020 that CMS uses for comparison with the preliminary November total is lower than the final February total by 552,394. In the last month for which a final total is available, the preliminary total in October is lower than the month's final total by 315,894.

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