START OF 2018 OPEN ENROLLMENT PERIOD

Time: D H M S

New York & California release updated Medicaid numbers: Far more woodworkers than I thought in each!

Huh. This is kind of weird...two completely different stories, from two different reporters (although both are via the Associated Press) about the latest Medicaid expansion numbers from two of the largest states at opposite ends of the country: California and New York.

This wouldn't be surprising if there had been a major report/press release regarding Medicaid enrollment nationally broken out by state, of course, but as far as I know there hasn't been (the last report from CMS came out in early June, only runs through March and doesn't distinguish between "traditional" and "expanded" Medicaid anyway).

In any event, I'm happy to report that the numbers actually line up pretty closely with what I already had estimated for each state:

NEW YORK: My estimates until now had NY at roughly 822K via official expansion, plus another 200K "woodworkers", or around 1.02 million total. It turns out I was fairly close on the total, but had the ratio between the two off:

ALBANY, N.Y. (AP) — New York has added 1.1 million people to Medicaid since the state health exchange opened last year in the national effort to connect the uninsured with low-cost coverage.

More than 6.2 million New Yorkers are now enrolled, almost one-third of its 19 million people.

At the same time, more than 525,000 other New Yorkers, already poor enough to qualify, enrolled. That was largely expected.

Also, the new computerized state-run system slowed the so-called "churn" that was annually kicking many eligible people out of Medicaid, often for months, Benjamin said.

If I'm reading this story correctly, it actually sounds like there were a lot more "woodworkers" who signed up in New York than I had estimated (525K vs. 200K), in addition to 575,000 "true expansion" enrollees...almost a 50/50 split. This flies in the face of the 2:1 or 3:1 expansion/woodworker ratio I've seen in other states so far.

It's also nice to see some recognition of the other reason why I tend to include "woodworkers" as being enrolled "due to" the Affordable Care Act--not only did the ACA include a massive education/outreach effort to encourage people who were already eligible for the program to sign up, but it also included funds to improve/streamline the enrollment process to make it faster and more efficient...which appears to be paying off now.

CALIFORNIA: For the Golden State, until now my Medicaid expansion estimate has been roughly 2.8 million "expansion" enrollees and around 600,000 "woodworkers", for 3.4 million new additions total. Once again, the actual total is a bit higher...but the ratio between the two is very different:

SACRAMENTO, Calif. (AP) — California has enrolled 2.3 million people under an optional expansion of the state's Medicaid program — nearly three times more than the state had anticipated, according to the state Department of Finance.

Beyond that, a record number of people who already qualified for the low-income health program signed up, pushing overall enrollment in the state's Medicaid program known as Medi-Cal past 12 million to roughly 1 in 3 Californians.

...Since California embraced Medi-Cal expansion, the state has seen enrollment surpass projections on all fronts. Not only did the state opt to extend coverage to adults without children and raise allowable income levels so more people could qualify, it also simplified enrollment, making it easier for those who were previously eligible to sign up and stay on the program.

The result has been an enrollment spike among both newly eligible people and California's existing Medi-Cal population. In January 2014, the state estimated a total of 1.4 million people would be added to Medi-Cal at a cost of $390 million for one year. In reality, 3.7 million people joined, costing the state more than $1 billion, according to state figures for the 2014-15 fiscal year.

OK, so that's a net increase of 3.7 million in CA (300K more than I had estimated), of which 2.3 million is ACA expansion and another 1.4 million is made up of woodworkers. That's about a 3:2 ratio...closer to the 2:1 ratio of Washington State, but still a far cry from the 4:1 ratio my previous California data suggested.

Interestingly, this article also finally makes note of the streamlining/increased-efficiency updates to the state Medicaid system.

In any event, between NY and CA, it looks like total Medicaid/CHIP enrollment is up nearly 400,000 more people than even I had estimated until now!

This updated information, coming from two such large states, also means that my estimate of the ratio between "expansion" and "woodworkers" has apparently been off by quite a bit as well. Until now I had it at roughly 3:1 nationally, which was likely the case last year. As we've moved into the 2nd year, however, it now looks like it might be closer to 2:1 overall.