Last night I posted an exclusive analysis of the ACA Medicaid/CHIP enrollment numbers (supported by, if not actually confirmed by an official at the Centers for Medicare & Medicaid Services) which concluded that rather than the 3.9 million that the HHS and Obama administration have been touting, or even the 4.5 million or so that has been on the ACA Signups spreadsheet for the past week or so, that the actual number could be closer to 6.4 million.
I should also note as an aside that after I pointed his error out in my entry last night, Glenn Kessler at the Washington Post Fact Checker changed his incorrect "750K" number for Oct/Nov HC.gov enrollments to 270K; I had noted that you have to include December to hit the 750K figure. I don't know whether he corrected it based on my story or not, but I'll assume he did for my own ego's sake :)
Two quick 'n simple updates: Oregon's "direct" Medicaid enrollments are up another 3,000, while the 86,000 total enrollments in Connecticut now have precise numbers (instead of ones based on percentages the other day). This knocks their private tally down by 880 while increasing the Medicaid number by the same amount.
More than three months after it was supposed to launch, Cover Oregon's website still can't enroll anyone from start to finish. Using a backup process that requires workers to process applications by hand, the state has managed to enroll 65,000 people in health coverage, about 23,000 of them in private insurance and the rest in the Oregon Health Plan, the state's version of Medicaid.
Another 118,000 have enrolled in Medicaid through a separate process that bypasses the exchange.
Access Health CT has signed up more than 86,001 customers by the end of Wednesday, which includes 43,840 people in private plans and 42,161 who learned they are income eligible for government-funded Medicaid.
For those who just want the capsule version, here it is:
The official ACA Medicaid/CHIP enrollment number that the HHS Dept. has been touting up until now has been 3.9 Million. The number that I've been claiming on the spreadsheet is currently around 4.5 Million. However, based on a very detailed analysis of the first 3 HHS reports, as well as the 2 CMS reports issued last fall, I've concluded that the actual grand total of Medicaid/CHIP enrollments since the ACA exchanges launched on October 1st is actually even higher, possibly as many as 6.4 Million. While they can't officially confirm my numbers and some caveats apply (described below), a CMS official did review my work and concluded that "the methodology appears to be accurate".
Now, before everyone starts freaking out about this claim--and it's an admittedly major one--I want to make two VERY important caveats:
...and, just like that, we're back up above the 10M grand total mark again. Connecticut's private QHP enrollment tally just increased from 40,000 to 44,720, cancelling out the 3,702 that we just "lost" from Nevada a few moments ago. Medicaid/CHIP enrollments also went up by several thousand.
As of Thursday morning, Access Health CT had enrolled a total of 86,000 people, said Kevin Counihan, the marketplace's chief executive. He said about 500 to 1,000 enrollees are being added a day. That means the marketplace, also called an exchange, is on track to meet or exceed its goal of enrolling 100,000 people once the open enrollment period ends on March 31, he said.
Of those 86,000 people, Counihan said 52 percent signed up for private coverage and 48 percent for government-funded Medicaid.
These 3 updates push the Private QHP enrollment tally up to about 2.4 million; add about 4.5 million Medicaid/CHIP enrollments and 3.1 million "sub-26'ers" added to their parents plan thanks to the ACA, and you hit just over 10 million total.
A few days ago the New York exchange released an oddly-worded press release which mixed some numbers through December 24 with other numbers through January 12. My reading of it at the time was that the state had added roughly 53,000 (private QHP + Medicaid/CHIP combined) since 12/30.
However, today, the Deputy Director of the NY exchange stated that they've been enrolling "about 7,000 per day" total in January...which adds up to 98,000 if you assume that runs through yesterday, the 14th. Even subtracting the extra 2 days, this means her number is 31,000 higher than yesterday's press release, but I'm not about to argue with the Deputy Director of the exchange, so another 98K it is. Assuming this breaks down roughly 72% Private QHP to 28% Medicaid/CHIP (as prior numbers have in NY), that comes to about 70.6K private and 27.4K public.
In addition, this pushes New York over the top in terms of their original CMS projection of 218,000 private QHP enrollments by March 31st. They should easily double that number by the end of the enrollment period, and could potentially hit 2.5x at this rate.
I really, really like the way that the Washington Health Exchange does their press releases. No screwing around, they make the key numbers clear and obvious, and they make sure to separate out unpaid private QHPs as well as Medicaid "redeterminations" (ie, those who already had Medicaid under the pre-ACA rules and are simply renewing it).
As a result, here's where Washington State stands as of January 9: Private enrollments went from 71,205 paid / 72,178 unpaid (143,383 total) to 73,098 / 76,058 (149,156 total), while new Medicaid enrollments increased from 177,065 up to 197,770.
Thus, since Jan. 2nd, WA has increased private QHPs by 4% and Medicaid enrollments by almost 12%.
As an added bonus, WA also separates out the other Big, Important Number: How many Medicaid enrollees are renewals vs. how many are new. I do not include renewals in the spreadsheet in cases where I can separate them out.
Qualified Health Plans: 73,098
Medicaid Newly Eligible Adults: 134,700
Medicaid Previously Eligible but not Enrolled: 63,070
Qualified Health Plan Applicants – Need to Pay 76,058
Some slightly updated numbers out of Oregon today, revealed during a conference call with the director of the beleaguered Cover Oregon exchange. Private enrollments are up from 20K to 23K, and exchange-based Medicaid enrollments up from 39,711 to about 42,000.
In addition, some info on the method of the 115,000 "direct transfers" to Medicaid off of the exchange: Apparently they used food stamp income information to do so, which is pretty clever if you think about it.
More than 65k enrolled so far through exchange, he says, 23k in private plans
I've already noted that the State-Level CMS Projection Numbers are, for 40 out of the 50 states (plus DC), not particularly well-arrived at. However, for good or for bad, those are the numbers that the states are "supposed" to be striving for, so let's take a look at how they're doing.
With the official 12/28 HHS numbers in hand plus more recent updates for 13 states, here's where things stand purely on a "% of CMS projection attained" basis.
This is important to understand in cases like Kentucky, which has actually been operating quite successfully but which shows up as performing "poorly" due purely to the absurdly high "projection number" that it was assigned in the first place.
The official HHS ACA Exchange Medicaid enrollment figure for Illinois released earlier today was 82,286. However, contributor sulthernao noted that the actual number of people enrolled in Medicaid under the ACA in Illinois is at least 53,714 higher. As he/she put it:
Illinois is a partnership state for Medicaid enrollment, has used SNAP autoenrollment, and early expansion experiment in Cook County. For this reason, the numbers reported by the Federal Government (ASPE) are a severe underestimate of the enrollment. People who apply directly through the state's website may not be counted.
I realize that this probably has no connection to the "mystery" 1.24 million Medicaid/CHIP enrollments that I just wrote about an hour or so ago, but it's been a very long day and I'm extremely tired, so until I hear a better explanation for those 1.24M, I'm lopping the 53K difference out of that "unspecified" total at the bottom of the spreadsheet.
OK, the Medicaid situation is, to put it mildly...confusing. For most of the states I simply swapped out whatever numbers were there from the November report for the Dec. 28 total. However, there are easily a dozen states which either have one-time bulk automatic transfers from an existing state-run program (such as the 630,000 transferred from California's LIHP program, which was itself created in preparation for the ACA's Medicaid Expansion program); earlier mass enrollments in Medicaid which were quietly put through via other ACA elements long before the actual Exchanges launched (see DC and Minnesota); "special" cases such as Arkansas' unique "private Medicaid option" program; or simply updated numbers which have been released since 12/28.
Even with all of this, there's still roughly 1.24 million "unspecified" Medicaid/CHIP enrollments which are necessary to make up the other "3.9 million" figure which the HHS Dept. has been touting since around December 20th. I am simply unable to determine exactly what these "unspecified" enrollments are, since the "normal" Exchange-based Medicaid/CHIP numbers only add up to about 1.58 million.
In short, as best as I can figure, it breaks down as:
Whew! OK, after plugging in the numbers from the December HHS report (which actually only runs through 12/28, which is important to keep in mind), I now have the spreadsheet as up to date as it can be. There are 12 states which have released more up-to-date enrollment figures since 12/28. When you add these more recent numbers to the 2.153 million in the HHS report (which, again, only covers through 12/28), you get the following total: 2,347,097
Now, some of this may be questionable, which is why it's clearly italicized on the spreadsheet. Specifically, there's 72,178 enrollees in Washington State who hadn't made their first payment as of January 2nd, and another 1,999 who haven't paid yet in Rhode Island. Finally, there's the confusing case of 22,000 people in Massachusetts who have apparently been approved but are just waiting on some paperwork processing to be completed; in the meantime, they've been put on some sort of temporary state-financed healthcare plan until this is resolved.