Analysis of recent national trends in Medicaid and CHIP enrollment

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This data note looks at national and state-by-state Medicaid and CHIP enrollment data through October 2022. After declining enrollment from 2017 to 2019, preliminary data for October 2022 shows total Medicaid/CHIP enrollment rising to 91.3 million, an increase of 20.2 million (28.5%) from enrollment in February 2020, just before the pandemic And that’s when enrollment began to rise steadily (Figure 1). The increase in enrollment may reflect changes in the economy, policy changes (such as the recent adoption of the Medicaid expansion in the Affordable Care Act), and the temporary continued enrollment provision created by the Families First Coronavirus Response Act (FFCRA). Under the continued enrollment provision, states generally cannot cancel the enrollment of Medicaid enrollees while the provision is still in effect and in return the states receive a temporary increase in the federal Medicaid match rate. In addition to preventing the loss of Medicaid coverage during the pandemic, the continuous enrollment provision has prevented churn in Medicaid – a temporary loss of coverage in which enrollment is canceled and then re-enrolled within a short period of time. As part of the Consolidated Appropriations Act, signed into law in December 2022, Congress will phase out the continuous enrollment provision on March 31, 2023, and phase out increased federal Medicaid matching funding through December 2023. States that accept increased federal funding can resume enrollment beginning in April 2023, but must meet certain reporting and other requirements during the unwinding process.

The information in this data note is based on a KFF analysis by the Centers for Medicare and Medicaid Services (CMS). performance indicators project data, Medicaid/CHIP enrollment data are submitted monthly by state Medicaid agencies and, with each monthly update, states often revise prior months’ enrollments to include retrospective enrollments and to better align with reporting criteria. Are. Except for the latest month’s enrollment (October 2022), this summarized report contains data from the updated enrollment reports for all other months to reflect the most current enrollment data possible. However, the data presented in this summary will differ from the data presented in the monthly Medicaid and CHIP enrollment snapshots published by CMS, which use the initial enrollment reports exclusively for all months.

Medicaid/CHIP enrollment increased following the implementation of the Affordable Care Act (ACA) but declined in the two years prior to the pandemic. Following the implementation of the ACA Medicaid expansion for low-income adults in 2014, states had a large increase in Medicaid and CHIP enrollment after a steady increase in coverage of children over the past decade. These increases are reflected in enrollment among newly eligible adults in states that expanded as well as enrollment among previously eligible adults and children, driven by increased outreach and enrollment efforts and updated enrollment procedures associated with the ACA. reason. This trend began to reverse when enrollment began to decline in 2018 and continued to decline in 2019. Total enrollment fell from 73.2 million in December 2017 to 70.9 million in December 2019, a decline of 2.3 million people, or 3.1%. The month-on-month enrollment decline slowed but continued through February 2020. Enrollment declines reflect, in part, a stronger economy, but the experiences of some states suggested they may also reflect enrollment losses among those who were still eligible for due coverage. For challenges completing the enrollment or renewal processes.

The data show that Medicaid/CHIP enrollment is increasing amid the coronavirus pandemic, increasing by 20.2 million enrollees or 28.5% from February 2020 to October 2022. During this period, all states saw total Medicaid/CHIP enrollment growth ranging from 17.4% to 77.7% (Figure 2). The state with the largest increase since February 2020, Oklahoma, implemented the Medicaid expansion on July 1, 2021. Four other states have implemented the extension since 2020 – Utah and Idaho in January 2020, Nebraska in October 2020, and Missouri (where the state began to process applications in October with retrospective coverage on 7/1/2021) Contributing to higher-than-average rates of enrollment growth in these states.

Virtually all of the growth was concentrated in Medicaid, which grew 31.1% (20.0 million enrollees) from February 2020 to October 2022 data (Figure 3). In contrast, CHIP has seen less enrollment growth since February 2020 (3.4% or 232,000 enrollees) and several states (18) have seen CHIP enrollment decline from the February 2020 through October 2022 report. These declines in CHIP enrollment in some states may reflect changes in family income that are causing children to move from CHIP to Medicaid coverage. As discussed below, all states reported an increase in children’s enrollment for Medicaid/CHIP overall during this time period.

Adult enrollment in Medicaid/CHIP has increased rapidly during the pandemic, with a reported 39.4% increase in enrollment from February 2020 to October 2022 (Figure 4). This increase equates to an additional 13.5 million adults in the 49 states and DC that report adult/child monthly enrollment (Arizona does not report children or adults separately). As noted above, five states introduced new enrollment expansions to adults beginning in January 2020 (Idaho, Missouri, Nebraska, Oklahoma, and Utah), contributing to the increase in adult enrollment. Children’s enrollment also increased, but at a slower rate: 17.6% or 6.2 million were enrolled in the same period. Nevertheless, every state reporting these data saw an increase in child Medicaid/CHIP enrollment since February 2020, despite declines in CHIP enrollment in some states (as discussed above).

Many may lose coverage as states begin rolling out enrollment again in April 2023 after the continuous enrollment provision expires. States will have up to 14 months as part to complete the reset and return to normal operations, although states can complete the reset more quickly. During this time, millions of people could be denied Medicaid if they no longer qualify or if they face administrative hurdles during renewal if they remain eligible. KFF estimates that between 5.3 million and 14.2 million Medicaid enrollees could be disenrolled in the months following the end of the continuous enrollment provision. How states manage the large amount of rescheduling during the “unwinding” of the continuous enrollment provision, as well as how states engage with enrollees and other stakeholders, will affect the continuity of coverage for millions of Medicaid enrollees.

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