At the New Year, pause to celebrate Medicaid

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Let's ring out 2020 with a final tracking of Medicaid enrollment during the pandemic.

In this 33-state sample, based on state monthly reports, Medicaid enrollment increased 11.1% from February through October, and an estimated 12.1%* from February through November. 

Since the increase reported in CMS's official tallies, currently running through a preliminary August report, generally show about a half percentage point slower growth** than my more up-to-date tally (8.3% vs. 8.8% for August), I imagine that CMS will show an increase of about 11.6%, February through November. That would mean 79.4 million people enrolled through November, an increase of about 8.25 million since February. [Update, 4/5/21: CMS's preliminary November total does indeed show an increase of 11.6% since February.]

State Medicaid enrollment totals in light of CMS's (lagging) reports

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Update, 12/21/20: CMS has just posted its preliminary August Medicaid/CHIP enrollment total: 76,489,912, up 8.3% since February (per below, CMS compares preliminary totals from each month for consistency; the final total for August will probably be 300-400,000 higher than the prelim). My own August estimate, based on state reports, was 8.7% growth since February. As I'm showing an 11% increase from February through October, CMS will probably come in at a bit over 10% - probably about 78.5 million total enrollment.

CMS's monthly tally of state-by-state Medicaid enrollment growth in this pandemic year is currently posted through July* -- reflecting five months in which enrollment was affected by the Covid-19 pandemic, and four-plus months in which the suspension of disenrollments mandated by the Families First Act was in effect. 

Most states post provisional Medicaid totals on state websites on a monthly basis, revising at varying intervals, and I have been tracking enrollment in 32 states in advance of CMS's 2-3-month lag. The available state reports vary somewhat from the the CMS tabulations, and both are adjusted retroactively. February-through-July is a large enough sample for me to compare my monthly tallies with the  CMS figures.

From February through July, in 32 states, I recorded a 7.4% increase in Medicaid enrollment.  Since CMS has so far only released its preliminary report for July, an apples-to-apples February-July comparison requires using CMS's preliminary rather than the updated February totals. With each month's new preliminary report, CMS reports updates the prior month state-by-state totals, and the updated totals are higher, as they include retroactive enrollment and enrollees whose applications were not finalized in the prior month. The February updated total is 405,491 higher than the preliminary February tally.** Comparing the preliminary totals for both months, as CMS does here, suggests a 6.9% increase nationally from February-July, and 6.8% in the 32 states I track, as the chart below shows. Links to the state-issued reports are provided at bottom.

The most recent published update to my 32-state sample derived from state-published supports suggests about 9.7% increase from February through September. Reducing that estimate proportionately to the July estimate would peg growth from February-September at 8.9%, suggesting total enrollment of about 77.5 million. [Update, 4/5/21: CMS's updated total for September is 77,682,409.] Totals look to be up more than 1% in October, putting enrollment above 78 million.

September update: ACA Medicaid expansion enrollment up 19% since February in 16-state sample

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Time for an update on "expansion" Medicaid enrollment in the pandemic months -- new enrollees since February rendered eligible by ACA expansion criteria. That is, adults with household income below 138% of the Federal Poverty Level who are not blind or disabled or eligible according to other pre-ACA criteria.

In 16 states that have reported expansion-category enrollees through September, enrollment in this category is up 19.2% since February, and 1.9% since August. That points toward perhaps 2.9 million new enrollees in this category -- minus perhaps 400,000 in California, which has had mysteriously weak Medicaid enrollment growth in the pandemic. A bit more than 2 million have likely been rendered "newly eligible" by the ACA.  See the previous post on pandemic expansion enrollment for details.

Pandemic Medicaid "expansion" enrollment in 16 states
February through September 2020

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Job losses and the uninsured rate in the pandemic: A one-state snapshot

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Let's try a somewhat ambiguous one-state snapshot -- in New Jersey, my home state --  of the extent to which ACA programs may have blunted an increase in the uninsured population during the months when Covid-19 triggered huge increases in unemployment. 

According to the New Jersey Department of Labor, job losses due to the pandemic peaked at about 835,500 and stood at 426,110 as of August. Estimates of the ratio between the number of people losing jobs and the number losing insurance vary quite a bit, and the ratio probably varies quite a bit by state, depending on the types of jobs lost. The pandemic created novel conditions, in which a fair number of workers were furloughed and were able to keep their job-based insurance, at least for a while. 

In New Jersey, as in most states that enacted the ACA Medicaid expansion, Medicaid is the primary safety net for the newly uninsured.  Enrollees rendered eligible by the expansion -- adults with incomes up to 138% of the Federal Poverty Level -- are driving rapid growth in Medicaid enrollment in the state. Here's the story since February: 

Medicaid Enrollment Growth in New Jersey in the Pandemic

Coverage group	Feb 2020	Sept 2020	Increase Feb-Sept	% increase Feb-Sep
ACA expansion adults	510,850	597,002	86,152	16.9%
Non-ABD children	773,544	835,543	61,999	8.0%
All Medicaid	1,682,621	1,853,928	171,307	10.2%

Source: NJ FamilyCare Monthly Enrollment Statistics

Medicaid enrollment (likely) up 9% since February

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As my post tracking pandemic Medicaid enrollment through August has gotten rather clotted with updates, I've posted the totals afresh below.

The big addition is California. The state has adjusted its August tally to a slight increase, in line with those of prior months, which have also been adjusted.  I am using the raw totals from the state database of certified eligibles. California's adjusted totals show a slightly bigger increase than previously, but still well below national averages, a mystery examined here. Adding California pulls down the 32-state increase from February through August by 1.7 percentage points.

For context and discussion of some data issues, such as how I reconcile states that report monthly totals  as of the beginning or end of each month, please see the prior post. In particular, the most recent update at the top of that post explains the basis of my estimate that Medicaid enrollment nationally is somewhere between 77.3 million and 77.6 million as of August, based on what's now a 32-state sample below. 

In brief, the 51-state enrollment increase from February thru August is probably about 9%. Nationally, Medicaid enrollment is now about 37% higher than it was in the third quarter of 2013, the pre-ACA point of comparison.

As the chart text was getting rather small, I've removed columns providing info about the programs each state tracks and the extent to which their tracking matches CMS's. See note, and chart with those columns retained, at bottom.

Estimate: ACA Medicaid expansion enrollment has increased by more than 2 million in the pandemic

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Ever since I was a child -- okay, ever since the ACA was a child -- I've been reading that 12 million Medicaid enrollees were rendered newly eligible by the ACA Medicaid expansion, which extended eligibility to adults with incomes up to 138% of the Federal Poverty Level (e.g., $1468 per month for an individual, $1303/month for a family of four). That's been the case since July 2016, rounding up from 11.6 million at that point. In June 2019, the last month tallied by CMS, enrollment of the "newly eligible" stood at 12.0 million.

A larger number -- 15.3 million in June 2019 -- are rendered eligible by ACA criteria and not by standard pre-ACA criteria. But 3.3 million of them are in states that had expanded adult eligibility to at least 100% FPL pre-ACA*. The federal government pays the ACA's enhanced "match rate" of 90% of costs for this larger group, classified as Group VIII.

Nationally, total Medicaid enrollment shrank by about 5% from early 2017 to early 2020.  Then came the pandemic.  As the economy crashed, Medicaid enrollment surged. It has probably increased by more than 6 million from the end of February through August. Here I'd like to venture an estimate, based on the enrollment data below: about 2.2 million of the new enrollees are ACA expansion enrollees. That would put current Group VIII enrollment at about 17.5 million.

If we assume that 78% of the new Group VIII enrollees are "newly eligible," that comes to about 1.7 million, raising current "newly eligible" enrollment to about 13.7 million. These enrollees stand to lose their coverage if the Supreme Court voids the ACA in its entirely.  And new enrollment triggered by the ACA expansion is far from over. In my 28-state tally (second chart here), the increase from July to August, 1.5%, is the same as from June to July.