Updated Medicaid/CHIP Enrollments w/Jan HHS Report Included

OK, given how messy and confusing the Medicaid/CHIP situation is, I had to think through the best way to incorporate the January HHS Report into the mix. The problem is that not only are the monthly HHS reports only part of the equation (the January CMS report probably won't be released for another 10 days or so, based on prior months), but it's not a simple "add HHS now, then add CMS later". The two actually intermingle, and some of the caveats and overlapping data changes from month to month, which means that some of the data I include today will have to be modified or removed after the CMS report is released, and some of the data which I've removed will have to be added back in...or part of it will, anyway.

Having said all that, I think I have a pretty good grip on how to do this now:

  • FIRST, I added a new column next to the October, November & December HHS reports for January, and plugged in the cumulative data for each state, making sure that it adds up to the same total (3,181,155) that the report adds up to.
  • Then, for each state, I subtracted the October, November & December enrollments so that the January column only includes that month's additional enrollments, not the cumulative total.
  • Next, I went through and removed the January enrollments for the following states: AZ, CA, CO, CT, DE, DC, IL, KY, MD, MA, MN, NY, ND, OR, RI & WA. I did this because all of those states have either already had their Medicaid/CHIP enrollments superseded by more recent data in the past week or so, or because I'm almost certain (based on the previous 3 monthly reports) that their January data will be superseded by the CMS report when it comes out. This is a bit of a leap of faith on my part, but if I'm wrong about any of these states I can always add the January HHS number back in at that time. I'd rather err on the side of caution here.

Doing all of the above brings the "High-End Range" from the current 7.33 million up to 7,750,364. This is an increase of around 420,000.

Remember, this number includes all 50 states (+DC) and some of the "out of the woodwork" and "normal churn" enrollees who were already eligible under the pre-ACA rules. The rest of these will be added when the CMS report is released, of course.

  • NEXT, I ruthlessly removed the total for all 26 non-expansion states (this includes Michigan, since our Medicaid expansion doesn't start until April).

Doing this lops the total down to 5,431,704, up from the current 5.3 million, for the new "Mid-Range" Medicaid/CHIP estimate, an increase of around 130,000.

  • FINALLY, I took the existing "Low-End" bare-bones "strictly ACA expansion only" estimate that I calculated a few days ago (based on a combination of the Avalere Health analysis and the "one-time bulk transfers" and individuals-vs-households factors I discussed the other day) and just added the 130,000 noted above to it.

Doing this gives a new low-end estimate of 2.53 million, which should not include any "normal churn" or "woodwork" enrollees, but only those who only qualify for Medicaid now due to the Medicaid expansion provisions of the ACA in the states which have actually expanded it.

The spreadsheet and graph have been updated with these 3 new figures, which will likely stay that way until the CMS report for January is released. I'm sure that report will have all sorts of new tweaks and headaches to take into account as well :)