Every month for years now, the Centers for Medicare & Medicare Services (CMS) has published a monthly press release with a breakout of total Medicare, Medicaid & CHIP enrollment; the most recent one was posted in late February, and ran through November 2022.
In November 2023, 85,815,827 individuals were enrolled in Medicaid and CHIP, a decrease of 1,503,283 individuals (1.7%) from October 2023.
78,710,401 individuals were enrolled in Medicaid in November 2023, a decrease of 1,523,107 individuals (1.9%) from October 2023.
7,105,426 individuals were enrolled in CHIP in November 2023, an increase of 19,824 individuals (0.3%) from October 2023.
As of November 2023, enrollment in Medicaid and CHIP has decreased by 8,034,913 individuals (8.6%) since March 2023, the final month of the Medicaid continuous enrollment condition under the Families First Coronavirus Response Act (FFCRA) and amended by the Consolidated Appropriations Act, 2023.
Medicaid enrollment has decreased by 8,007,036 individuals (9.2%).
CHIP enrollment has decreased by 27,877 individuals (0.4%).
Between February 2020 and March 2023, enrollment in Medicaid and CHIP increased by 22,975,671 individuals (32.4%) to 93,850,740.
Medicaid enrollment increased by 22,637,644 individuals (35.3%).
CHIP enrollment increased by 338,027 individuals (5.0%).
Normally, states will review (or "redetermine") whether people enrolled in Medicaid or the CHIP program are still eligible to be covered by it on a monthly (or in some cases, quarterly, I believe) basis.
However, the federal Families First Coronavirus Response Act (FFCRA), passed by Congress at the start of the COVID-19 pandemic in March 2020, included a provision requiring state Medicaid programs to keep people enrolled through the end of the Public Health Emergency (PHE). In return, states received higher federal funding to the tune of billions of dollars.
As a result, there are tens of millions of Medicaid/CHIP enrollees who didn't have their eligibility status redetermined for as long as three years.
I strongly suspect that at least one of the remaining holdout states will join the expansion crowd this year, most likely Georgia, Mississippi or Alabama...but it likely will be some state-specific variant as described above. Stay tuned...
...As I noted, however, in all three [states] it's pretty likely they'll go with at least a partially privatized version as Arkansas has instead of a "clean" expansion of Medicaid proper.
Of course, as one Alabama-based advocate put it...
“Our partners provide a crucial one-on-one service to help Coloradans get covered,” said Connect for Health Colorado’s Chief Executive Officer, Kevin Patterson. “They help us make sure local communities, especially those who face barriers in getting health coverage, can access the plans and savings we offer. I encourage interested organizations and current partners to apply.”
HARTFORD, Conn. (Feb. 20, 2024) — Access Health CT (AHCT) today announced it will host two free, in-person enrollment fairs in February and March to help HUSKY Health enrollees who have been affected by the Medicaid Unwinding process. The events will take place in New Britain and Stamford.
Medicaid Unwinding is the process of resuming the review of households for Medicaid eligibility after a three-year break during the Public Health Emergency. The eligibility redetermination process resumed April 1, 2023 and HUSKY Health clients will be notified when it is their turn to enroll. The process will end March 31. HUSKY Health is Connecticut’s Medicaid program.
Connecticut residents who remain eligible for HUSKY Health will likely be automatically reenrolled. Those who need to take action will receive mail with instructions.
February 23: CMS approved a postpartum coverage extension state plan amendment (SPA) for Alaska (link to come). This SPA approval will extend comprehensive coverage after pregnancy through Medicaid and the Children’s Health Insurance Program (CHIP) for a full 12 months. The approval of Alaska’s SPA marks critical progress in implementing the CMS Maternity Care Action Plan, which supports the Biden-Harris Administration’s Maternal Health Blueprint, a comprehensive strategy aimed at improving maternal health, particularly in underserved communities. Alaska is the 44th state, including D.C. and the U.S. Virgin Islands that have extended postpartum Medicaid coverage to a full year, made possible by President Biden’s American Rescue Plan (ARP), and made permanent by the Consolidated Appropriations Act, 2023 (CAA, 2023), which President Biden signed into law in December 2022.
February 16: CMS approved coverage expansions in Arizona through an amendmentof two policies, “Parents as Paid Caregivers” (PPCG) and “KidsCare Expansion." Approval of the Parents as Paid Caregivers amendment will allow the state to continue to reimburse legally responsible parents for providing direct care to their minor children, helping to mitigate the direct care worker shortage and improve access to timely, effective care in the home and community.
Additionally, the KidsCare Expansion amendment will allow the state to increase the Children’s Health Insurance Program (CHIP) eligibility thresholds from 200% of the federal poverty level (FPL) to 225% of the FPL. Expanding KidsCare is expected to improve the rate of child health insurance coverage, increase access to affordable health care coverage, decrease costs by addressing health needs earlier, when care is less expensive, and provide financial relief for families. The demonstration will remain in effect until September 30, 2027.
Right on top of my last post regarding Maryland moving legislation to allow undocumented immigrants to enroll in ACA exchange policies (at full price) is this story out of Connecticut:
Advocates spoke before the Connecticut Appropriations Committee on Wednesday, pushing to include more immigrant children in the Husky Medicaid program.
The hearing before the budget committee witnessed a significant turnout, with 260 individuals offering testimonies supporting Husky expansion in the upcoming state budget. Advocates emphasized the need to close the coverage gap for immigrant and undocumented children aged 16 to 18.
...Segovia says it is difficult to come up with an estimated cost to cover the population between 15 and 18, but it could be approximately $4.5 million. While this may seem significant, she emphasized the long-term benefits of health care access to vulnerable communities, outweighing the minimal budgetary impact.
One of the most inane restrictions of the ACA in my view, as I noted in my "If I Ran the Zoo" wish list back in 2017, is that, by default, it doesn't allow undocumented immigrants to enroll in ACA marketplace health plans ("Qualified Health Plans" or QHPs).
I don't just mean that they aren't eligible for federal financial subsidies--that's a prohibition which I can at least understand, even if I don't agree with it. I mean that they aren't allowed to enroll in ACA exchange-based QHPs even at full price, as noted in Section 1312(f)(3):
(3) Access limited to lawful residents.--If an individual is not, or is not reasonably expected to be for the entire period for which enrollment is sought, a citizen or national of the United States or an alien lawfully present in the United States, the individual shall not be treated as a qualified individual and may not be covered under a qualified health plan in the individual market that is offered through an Exchange.
Governor Murphy and Acting Commissioner Zimmerman Announce Record-Breaking 397K People Signed Up for Health Insurance Through Get Covered New Jersey During Open Enrollment
Enrollment Up 61% Since the Murphy Administration Assumed Operation of the Health Insurance Exchange
Residents with a Qualifying Life Event or Who Meet Certain Income Levels Still Have Options to Get Covered
TRENTON —Governor Phil Murphy and Department of Banking and Insurance Acting Commissioner Justin Zimmerman today announced that more than 397,000 New Jerseyans signed up for health coverage through Get Covered New Jersey during the Affordable Care Act Open Enrollment Period, marking another year of historic enrollment in New Jersey.
The headline says 397K but it's actually just shy of 398K.
I strongly suspect that at least one of the remaining holdout states will join the expansion crowd this year, most likely Georgia, Mississippi or Alabama...but it likely will be some state-specific variant as described above. Stay tuned...
A Medicaid expansion bill will arrive in the Mississippi Senate by Monday, beginning a process that could provide health care to about 230,000 working Mississippians, Lt. Gov. Delbert Hosemann says.
I strongly suspect that at least one of the remaining holdout states will join the expansion crowd this year, most likely Georgia, Mississippi or Alabama...but it likely will be some state-specific variant as described above. Stay tuned...
I've butted heads with California Democratic Congressman Ro Khanna a few times, most notably nearly four years ago over his misrepresentation of the role private health insurance would play under a theoretical Bernie Sanders-style "Medicare for All" system.
However, I also believe in giving credit where its due, and a new bill introduced by Rep. Khanna (with 29 cosponsors, most of whom seem to be members of the Progressive Caucus, as you'd expect) seems petty damned reasonable to me:
NC Medicaid Expansion Continues to Bring Health Care to More North Carolinians
PRESS RELEASE — As of Feb. 1, 2024, 346,408 newly eligible North Carolinians are enrolled in Medicaid and now have access to comprehensive health care, according to the North Carolina Department of Health and Human Services’ Medicaid Expansion Enrollment Dashboard. NCDHHS released an updated the dashboard today, and it includes enrollment data as of Feb. 1, 2024. This number is more than half of the anticipated 600,000 people who are newly eligible for coverage, expected to enroll in Medicaid expansion over the next two years.
"In the first two months we have already enrolled over half of the eligible people," said NC Health and Human Services Secretary Kody H. Kinsley. "These individuals and families are seeing providers, utilizing preventative and specialty care, and getting life-saving prescriptions."
SACRAMENTO, Calif. — Covered California has opened the application process for its Navigator Program, with up to $33.9 million to be granted over the next three years to community organizations that help individuals and families become aware of and enroll in health insurance, with a focus on diverse and underserved communities.
The application process will run until March 15. For this Navigator Program funding cycle, the total annual budget has nearly doubled, increasing from $6.5 million to up to $11.3 million per year.
“Covered California’s success over the past decade is due in great part to the tremendous Navigator Program grantees that have helped Californians understand their health care options and get the coverage they need,” Executive Director Jessica Altman said. “The increased funding this year is a testament to the effectiveness of this program and will help strengthen our efforts to reach the most vulnerable Californians where they are.”
We still get calls on a regular basis from people who are shopping for individual insurance because adding dependents to their employer plan is prohibitively expensive. We estimate that roughly 20 percent of the people who contact us are in this situation.
Unfortunately, due to a “glitch” in the ACA, they are not eligible for premium subsidies in the exchange if the amount the employee has to pay for employee-only coverage on the group plan is deemed “affordable” – defined as less than 9.78 percent of household income in 2020.
Gov. Ron DeSantis’ administration has filed suit to challenge a new federal requirement that specifies when children can be removed from the state’s Children’s Health Insurance Program.
...At issue is a Biden administration rule that took effect Jan. 1 requiring states to provide 12 months of continuous eligibility for enrollees ages 18 and younger under Medicaid and CHIP, even if monthly premiums are not paid.
Georgia is one of just ten remaining states which is still holding out on fully expanding Medicaid to all legal residents earning up to 138% of the federal poverty level under the Affordable Care Act. Instead, back in 2019, GOP Georgia Governor Brian Kemp submitted a Section 1115 waiver which included a plan to partially expand Medicaid to some uninsured Georgia residents...except with a work reporting requirement for enrollees attached to it.
The program was called "Georgia Pathways," it was approved by the Trump Administration, and unlike several other states which had work requirement provisions shot down by various judges, Georgia's managed to slip through. It was scheduled to go into effect in 2021 and was supposed to be valid until September 30, 2025 before having to be resubmitted for renewal.
The incoming Biden Administration's HHS Dept. put the kibosh on the work requirement provisions of the program. Georgia successfully challenged the administration and Georgia Pathways went into effect last summer...but is still currently scheduled to sunset next September.
Back in November, I noted that Georgia, one of the ten states STILL refusing to expand Medicaid coverage to hundreds of thousands of low-income residents a decade after they could have done so under the ACA, may finally be coming around...albeit via a rather silly & inefficient method. via the Atlanta Journal-Constitution:
Could Georgia adopt an Arkansas-style Medicaid plan?
Senior Republicans see an opening for a health care overhaul
Key Republicans say they’re open to legislation that would add hundreds of thousands of poor Georgians to the state’s Medicaid rolls — and bring in billions of federal dollars to subsidize it — as part of a compromise to roll back hospital regulations.
Certified Enrollment Assistors Visit Colleges Across New York State
New Yorkers Who Enroll by February 15 Will Have Coverage in Place for March 1
ALBANY, N.Y. (February 9, 2024) – NY State of Health, the state’s official health plan Marketplace, today announced an informational college campaign, with events taking place on campuses throughout New York State. Certified enrollment assistors will be visiting schools to talk to students about affordable, quality health insurance through the Marketplace, and help current enrollees renew their coverage. Enrollment for 2024 coverage is currently open for Medicaid, Essential Plan, Child Health Plus, and Qualified Health Plans (QHP). Consumers who enroll by February 15 will have coverage for March 1.
With its open-enrollment period ending on Feb. 9, Covered California announced that a record number of Californians have selected health plans for 2024.
As of Jan. 31, there are 1,784,653 Californians who have chosen a health plan through Covered California for 2024, with 306,382 new enrollees and 1,478,271 renewing their coverage. The total surpasses the previous high set in 2022.
The increased federal subsidies through the Inflation Reduction Act paired with California’s new cost-sharing reduction program for 2024 helped create the highest number of new sign-ups during an open-enrollment period since 2020. Consumers have until midnight on Feb. 9 to enroll in coverage that would be effective as of Feb. 1.
Below I've done the same thing for ACA Medicaid Expansion. The data comes from the Centers for Medicare & Medicaid Services quarterly Medicaid Budget & Expenditure System reports.
*Unfortunately the MBES reports only run through June 2023, so it's missing 6 months of updates (which have likely shown a small drop in ACA Expansion Medicaid enrollees due to the ongoing Unwinding process). It therefore actually only includes 10 1/2 yrs of enrollment data.
No further analysis or comment here; I just think this is a pretty cool graphic...and keep in mind that most of the ~24.5 million people represented here would have been utterly screwed from early 2020 - early 2023 without the Affordable Care Act being in place when the pandemic hit. Click the image for a higher-resolution version; the states are listed on the right-hand side, though they might be difficult to make out (also note that Guam, Puerto Rico and the U.S. Virgin Islands also have a number of ACA expansion enrollees shown):
There's still likely up to perhaps ~25,000 or so Qualified Health Plan (QHP) enrollments to be added to the 2024 Open Enrollment Period (OEP) tally from the states which haven't reported their final, post-1/16 enrollments (in fact, CA & NY technically haven't ended theirs yet, but I decided to throw this together today for the hell of it.
The table below charts the first eleven years of ACA Open Enrollment Periods, broken out by state. I've also included Basic Health Plan (BHP) enrollment in Minnesota & New York, the only states where BHP programs have been implemented to date (Oregon is scheduled to launch theirs this summer, I believe).
