I just stumbled on a little Medicaid factoid (ex-post, as always...) that made my eyes pop.
As I've been noting for months, enrollment growth during the pandemic in the ACA Medicaid expansion population has been about double the rate of overall Medicaid enrollment growth -- about 30% for expansion population, February 2020 to February 2021, versus about 15% overall.
The locus of rapid enrollment growth can perhaps be narrowed further. Arizona breaks out the ACA expansion population into two income categories: 0-100% FPL and 100-138% FPL. From April 2020 to April 2021, enrollment in the 0-100% FPL category increased by 21% from 133,514 to 204, 298. In the 100-138% FPL category, enrollment increased by 94%, from 76,121 to 147,775.
Michigan provides the same income breakout, though I had to use the Wayback Machine to get a total for April 2020 (as of April 20 of that year). From that date to April 5, 2021, enrollment at 0-100% FPL increased 25%, from 555,104 to 692,963. In the 100-138% FPL bracket, enrollment increased 53% in the same period, from 133,514 to 204,298.
Virginia breaks the pattern. From May 2020 to April 2021 (no data for April 2020), enrollment increased 35% in the under-100% FPL bracket, and just 16% at 100-138% FPL. I will speculate that since Virginia did not enact the expansion until 2019, while Arizona and Michigan expanded in 2014, enrollment in the larger 0-100% FPL pool was further from full capacity in Virginia as of early 2020 than in the states where the expansion was entering its eighth year. Medicaid expansions take a while to shake out, as Virginia's sharp marketplace enrollment drop at low incomes from 2018-2020 illustrates.
I'll speculate also as to what I think will prove to be the general pattern: more rapid enrollment growth at 100-138% FPL. Perhaps more people who lost job-based coverage in the pandemic, or dropped down from marketplace coverage to Medicaid, landed in the higher income category. Also, those nearest the eligibility threshold are perhaps likeliest to be disenrolled by regular state income checks in normal years. The Families First Act, enacted in March 2020, effectively required states to pause disenrollments for the duration of the emergency, which is ongoing.
I have not found other state reports that break out expansion Medicaid enrollment in these two income brackets. If anyone knows of any resources on this front, please ping me.
I'm wondering if the increase may have partially resulted in presumptive Medicaid enrollment in acute care settings. I'm not sure; however, my brother, who has BCBS, ended up in the ICU as a result of COVID-19. Luckily, he made it through; however, he was presumptively enrolled in Medicaid, because the hospital was unaware of his health insurance.
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