Time for an update on Medicaid expansion enrollment growth since the pandemic struck. Below is a sampling of 19 expansion states through January of this year, and 14 states through February.
Maintaining the assumption, explained here, that relatively slow growth in California would push the national total down by about 2.5 percentage points, these tallies still point toward year-over-year enrollment growth pushing 30% from February 2020 to February 2021. If that's right, then Medicaid enrollment among those rendered eligible by ACA expansion criteria (adults with income up to 138% FPL) may exceed 19 million nationally and may be pushing 20 million. That is, if this sampling of a bit more than a third of total expansion enrollment represents all expansion states more or less accurately, again accounting for slower growth in California.
Totals in the bottom row are for the 14 states that have reported results through February 2021.
Expansion Medicaid enrollment in select states
February 2020 through February 2021
As always, I attribute totals posted before the end of one given month to the prior month, so that a total posted on March 1 or later in the month and labeled "March" on the state site is presented here as "thru February." For more context, see (again) this post, which links back to earlier discussions of method and assumptions.
And let's pause to mentally update this year-end celebration of Medicaid -- and the ACA Medicaid expansion in particular -- as a safety net in the pandemic.
As usual, my focus is that some of those 19 million people with expanded Medicaid (aged 55-64 in about 12 expansion states) don't have insurance at all. Due to state Medicaid estate recovery policies, they get a loan until death for whatever medical expenses happen to occur.
ReplyDeleteThus, the contraption of the ACA within our complicated health insurance system switches many people down to having a loan until death for medical expenses when they happen to drop below 138% of the Federal Poverty Level (FPL). Above 138%, to 150% now (COVID bill for 2 years), they get 100% subsidized real insurance. Many more over 150% FPL get mostly subsidized on exchange real insurance. In fact, with the temporary removal of the subsidy cliff, many over 400% FPL get their real, not-just-a -loan, health insurance subidized by 2/3 and more.
The recent annual Federal MACPAC ("Medicaid and CHIP Payment and Access Commission") commission just released a report addressing Medicaid estate recovery in its 3rd Chapter:
https://www.macpac.gov/wp-content/uploads/2021/03/Chapter-3-Medicaid-Estate-Recovery-Improving-Policy-and-Promoting-Equity.pdf
It has some useful information, but it declined to recommend all states stop the estate recovery on expanded Medicaid (and other non-long-term-care Medicaids) in order to make the ACA provide real insurance for all.
It did recommend that the Federal mandate on states to recover long-term-care Medicaids be removed.
("States should have the option to eliminate estate recovery. This would allow those that determine the return on their investment is low to cease recovery, while permitting states that find estate recovery useful to continue the practice.")
But it apparently lacked the courage and clarity of thought to point out that the ACA fails at its promise, and has a wild, pernicious "just a loan for medical expenses" cliff at 138% FPL (below), if any state recovers non-long-term-care Medicaids.
The document also summarizes its prior failure to recommend stopping non-long-term-care recovery post ACA main provisions:
"The Commission last engaged on this issue in 2015, when media reports raised concerns that estate recovery could be a barrier to enrollment for the new adult group in states that expanded Medicaid under the Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended). MACPAC published an issue brief on the implications of estate recovery for the new adult group, but did not make any recommendations (MACPAC 2015)."
The report also indicates that the estate recovery is in more Medicaid expansion states than I had believed. From other sources, and my own known examples, I had believed the number was about 12 expansion states. The Chapter reports it is 20.
("In our recent review of state plans, we found that 20 expansion states
and the District of Columbia pursue recovery for non-LTSS benefits for individuals who received Medicaid at age 55 or older, and 18 states do not (Appendix 3C)."