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.
According to the official December HHS report, the total number of exchange-based private enrollments was 2,153,421 as of 12/28.
ACASignups.net was, therefore, appx. 99.2% accurate (ok, knock 0.2% off for the missing 3 days of data...call it 99% even).
I have no idea why the HHS report doesn't include the last 3 days of the year; perhaps a lack of personnel during the holidays? Will post something about this if/when I find out what the deal was there.
OK, I've plugged the numbers into the spreadsheet, but since most people's browsers won't be wide enough to view it, here's the state-by-state breakdown; remember, these numbers are only through 12/28:
Rhode Island becomes the 2nd (or possibly 3rd, depending on how New York's final tally turns out) state to break through the CMS's private enrollment projection, hitting 12,300 when employees enrolled via the Small Business exchange are included (and yes, these count. They're still people who didn't have insurance prior to the ACA, who do now thanks to a part of the ACA).
This moves RI up from an 80% paid rate as of New Year's Eve to an 83% paid rate as of January 8th. The rest will have to wait until February for coverage at this point.
Nearly 2,000 people of the 11,770 who signed up for health insurance through HealthSource RI did not pay their premiums by the Jan. 8 deadline...
The numbers show that 23 percent of enrollees are age 18 to 34, and 56 percent are 45 or older. Also, 54 percent are female. These numbers are based on the figure of the 11,770 who selected a plan by Jan 4....
Some 75 small businesses have enrolled, with coverage for a total of 530 people.
A friend who wishes to remain anonymous provides a bit more info on the MinnesotaCare program discussed earlier.
The program seems similar to California's Low Income Health Program. The LIHP wasn't part of Medicaid, but it was set up with federal funds in preparation for Medicaid Expansion. However, Minnesota Care predates the ACA. It began in 1992. Part of its funding comes from federal Medicaid funds:
"MinnesotaCare is a publicly subsidized health care program for residents who do not have access to affordable health care coverage. It is funded by a state tax on Minnesota hospitals and health care providers, federal Medicaid funds and enrollee premiums.
Most enrollees pay a monthly premium based on family size and income. Children under 21, some military families, and families with an enrolled American Indian do not pay a monthly premium.
Still waiting for clarification of the distinction between private enrollments and Medicaid/CHIP expansion on the new additions, but assuming they're a similar ratio to the prior enrollments, it should be roughly 38,500 private and 14,500 Medicaid/CHIP. If that ratio is close, this means that New York has essentially reached their March 31st private enrollment projection of 218,000 (give or take a few thousand).
Bonus: It was also revealed during NY State Senate testimony today that a whopping 40% [Ed: 30%, thanks to DwightKSchrute for the correction] of enrollees are under 35, and another 16% are between 34-44. This should go a long way towards quieting the ""young invincibles" aren't signing up!" ACA attack point.
A regular site visitor has sent me some in-depth information about the public healthcare program situation in Minnesota, which is evidently quite a bit more complicated than most other states. I've put together this information into what I hope is a cohesive whole, with my response below. Anyone who's more familiar with the Minnesota situation can feel free to correct or clarify any of this if you'd like.
"Of those nearly 72,000 enrollees, slightly more than 26,000 signed up for private insurance while the rest are on public plans."
Several thousand more than 26,000 should be counted as exchange sign-ups rather than Medicaid signups. Minnesota has a sort of in-between basic health plan called MinnesotaCare. It covers people between 133% and 200% (I think?) of poverty. It is not Medicaid (which is called Medical Assistance in Minnesota) and therefore not part of the ACA Medicaid expansion, but it is a public plan. So, when the StarTribune refers to "public plans," they are lumping Medicaid and MinnesotaCare together. The state has cleared this up before in reporting on Minnesota's enrollment numbers in the New York Times. MinnPost reported on this correction back in November.
As a follow-up to Friday's news that Idaho has hit around 20,000 private enrollments comes this story about the status of those enrollments from the actual insurance companies' perspective. While the major thrust of the article is the unusually long payment deadline extensions that have become necessary due to the technical and paperwork confusion caused by the Federal HC.gov exchange, as contributor Witgren notes, there's two important points which are quite telling.
First, in Idaho, at least, it appears that at least 75% of those 20K people have made their first payment. While you can certainly spin this as being "25% are deadbeats" if you want to, this certainly goes a long way towards disproving that the "OMG!! NOBODY IS ACTUALLY PAYING!!!" meme that the ACA opposition has been shouting about.
Secondly, it appears that, according to the insurance companies themselves, having a large percentage of new policy purchasers not make their payment until the last possible moment is standard for the industry as a whole, and has been for a very long time.
Right after last night's South Dakota update we have their sister state to the North. ND was at just 265 private enrollments as of 11/30, so this represents a four-fold increase as of January 7. I've subtracted 800 from the "unspecified" pool at the bottom of the spreadsheet to compensate.
Meanwhile, their Medicaid expansion has gone from 1,001 up to around 1,700.
As of the first week of January, when coverage started through plans under the Affordable Care Act, 977 members had signed up with Blue Cross Blue Shield of North Dakota, the state’s dominant insurer.
The Sanford Health Plan enrolled 92 in North Dakota through the new marketplace exchange.
By contrast, enrollment in North Dakota under expanded Medicaid eligibility stands at about 1,700 in the first week of January....
In North Dakota, estimates of new Medicaid enrollees under the expanded eligibility have ranged from an increase of 20,000 to 32,000.
A 42% increase from South Dakota since 12/23 is pretty good by itself. However, this number only covers 2 of the 3 insurance companies participating in the exchange. I have no idea what sort of market share the 3rd company has in SD, so I can't speculate as to how many more enrollments they have to add to the total.
I've also subtracted a the corresponding 1,000 difference from the "unspecified" Federal pool at the bottom of the spreadsheet to compensate.
As of Jan. 1, about 3,550 people in South Dakota had signed up through the federal marketplace website from Avera and Sanford, with about 2,700 from Avera and about 850 from Sanford. DakotaCare figures weren’t available.
Who would have thought that it would be Idaho, of all states, that would mark the first significant milestone since hitting the 2.1 million mark a around Christmas? In any event, the spokeswoman for Your Health Idaho announced that ID has shot up from just 1,730 private enrollments at the end of November to a whopping 20,000 people "in time for January 1st". Since the final January deadline for Federal exchange states was Christmas Eve, I assume this means that an additional 18,270 people enrolled from 12/01 - 12/24, increasing Idaho's total 11-fold.
Of course, most of those 18K new people will probably have to be taken out of the HHS's non-specific "1 million" enrollments which haven't been officially broken out by state, but even after doing so, the total number of private enrollments now still sits at just over the 2.2 million mark.
At the same time, since Idaho's CBO projection for 3/31/14 was only 40,000 people to begin with, this means that just like that, they've jumped up to 50% of their target.
Maryland added another 2,093 people to the private exhange rolls from 12/28 - 01/04, a 11% increase. The Medicaid situation is a bit more confusing: Actual enrollments increased from 19,578 to 26,500 (a 35% increase), but the prior week's tally had it at 43,065. It turns out that about 20,000 or so of the Medicaid applications need to be double-checked for duplicates, so they can't be counted yet, making it look like a huge drop by comparison. Sorry about that, folks.
As of Jan. 4, just over 20,350 people had enrolled in private insurance plans on the Maryland health exchange, up 2,100 from the week before, according to a weekly report by exchange officials. The pace of enrollment slowed from recent weeks.
...About 26,500 people had enrolled through the exchange in Medicaid, the federal-state health program for the poor, according to the latest numbers, up some 7,000 from the previous week. Tens of thousands more have been found eligible, but officials say many might be duplicate applications.
"Churning" describes the process by which an estimated nine million people move off Medicaid every year when their income increases, perhaps because of a seasonal job, and then move back when their income drops. Usually, people churning out of Medicaid have remained without health care coverage until they re-enroll again.
Now, because of the Affordable Care Act, people who leave a Medicaid managed care plan may temporarily qualify for subsidized insurance through the exchanges, but they may experience gaps in coverage or have to change health plans or doctors as they move back and forth. The director of the National Association of Medicaid Directors, quoted in a Kaiser Health News article, explains the challenge: