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...
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."
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.
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):
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.
In October 2023, 87,289,666 individuals were enrolled in Medicaid and CHIP, a decrease of 1,160,543 individuals (1.3%) from September 2023.
80,227,593 individuals were enrolled in Medicaid in October 2023, a decrease of 1,210,160 individuals (1.5%) from September 2023.
7,062,073 individuals were enrolled in CHIP in October 2023, an increase of 49,617 individuals (0.7%) from September 2023.
As of October 2023, enrollment in Medicaid and CHIP has decreased by 6,561,074 individuals (7.0%) 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 6,489,844 individuals (7.5%).
CHIP enrollment has decreased by 71,230 individuals (1.0%).
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%).
Mississippi is one of the ten states where ACA Medicaid expansion still hasn't gone through a full decade after it could have.
A few years ago, Medicaid expansion in Mississippi looked like it might actually happen: While the states GOP Governor and Republican supermajority-controlled state legislature opposed it, in May 2021 there was a strong grassroots effort to put a statewide initiative on the ballot to push it through regardless, exactly how it happened in other deep red states like Utah, Nebraska, Idaho and South Dakota.
On the other hand, well, at least if women manage to survive childbirth, they & their newborn baby will have Medicaid coverage for a full year in the future. Via the Austin American-Statesman:
Texas mothers are one step closer to getting health coverage for 12 months following pregnancy.
This week, the federal Centers for Medicare and Medicaid Services approved Texas' plan to provide 12 months of postpartum health care coverage through Medicaid or Children's Health Insurance Program instead of the current 60 days. Those programs are for people who qualify based on income. The extended coverage will begin March 1.
Back in September, Inside Health Policy reporter Dorothy Mills-Gregg checked in on "Georgia Pathways," the Peach State's new program which partially expands Medicaid to residents earning up to 100% of the Federal Poverty Level (FPL), but with a rather significant string attached: Work reporting requirements:
...in spite of nearly every state which tried to (or succeeded in) implement Medicaid work requirements having their programs shut down by the courts, one state's work/reporting managed to survive: Georgia. As explained in the Kaiser article:
