Medicaid Expansion

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Moments ago I posted the news that the HHS Dept. (via the Centers for Medicare & Medicaid) has confirmed what I wrote about nearly a month ago: Enrollment in ACA healthcare policies are at an all-time high, with over 31 million Americans currently covered by either ACA exchange plans, ACA Medicaid expansion or ACA Basic Health Plan coverage.

This news is based on a formal report issued by the Assistant Secretary for Planning & Evaluation (ASPE). Let's take a closer look!

Health Coverage Under the Affordable Care Act: Enrollment Trends and State Estimates

Based on enrollment data from late 2020 and early 2021, approximately 31 million people were enrolled in Marketplace or Medicaid expansion coverage related to provisions of the Affordable Care Act (ACA), the highest total on record.

KEY POINTS

ACA Signups Logo

A month ago I noted that by my back-of-the-envelope math, total enrollment in ACA healthcare coverage had likely reached 30 million people, concluding that:

#ACA Enrollment Is At An All-Time High Right Now Almost Any Way You Slice It.

I based this on a rough comparison of ACA enrollment in 2016 (which saw the highest ACA Open Enrollment Period enrollment to date, with nearly 12.7 million people selecting Qualified Health Plans (QHPs) during the official OEP) versus the most recent data available as of spring 2021.

My rough math was as follows (spring 2016 / spring 2021):

Indiana

I've once again relaunched my project from last fall to track Medicaid enrollment (both standard and expansion alike) on a monthly basis for every state dating back to the ACA being signed into law.

For the various enrollment data, I'm using data from Medicaid.gov's Medicaid Enrollment Data Collected Through MBES reports. Unfortunately, they've only published enrollment data through December 2020. In some states I've been able to get more recent enrollment data from state websites and other sources.

Today I'm presenting Indiana. For enrollment data from January 2021 on, I'm relying on adjusted estimates based on raw data from the Indiana Family & Social Services Administration.

Illinois

I've once again relaunched my project from last fall to track Medicaid enrollment (both standard and expansion alike) on a monthly basis for every state dating back to the ACA being signed into law.

For the various enrollment data, I'm using data from Medicaid.gov's Medicaid Enrollment Data Collected Through MBES reports. Unfortunately, they've only published enrollment data through December 2020. In some states I've been able to get more recent enrollment data from state websites and other sources.

Today I'm presenting Illinois. For enrollment data from January 2021 on, I'm relying on adjusted estimates based on raw data from the Illinois Dept. of Healthcare & Family Services.

Idaho

I've once again relaunched my project from last fall to track Medicaid enrollment (both standard and expansion alike) on a monthly basis for every state dating back to the ACA being signed into law.

For the various enrollment data, I'm using data from Medicaid.gov's Medicaid Enrollment Data Collected Through MBES reports. Unfortunately, they've only published enrollment data through December 2020. In some states I've been able to get more recent enrollment data from state websites and other sources.

Today I'm presenting Idaho, which only actually implemented Medicaid expansion under the Affordable Care Act starting in January 2020...and thank God they did, because less than 2 months later everything hit the fan when the COVID pandemic hit the U.S., hard. In Idaho's case I've gotten data through April directly via the Idaho Dept. of Heath & Welfare.

Hawaii

I've once again relaunched my project from last fall to track Medicaid enrollment (both standard and expansion alike) on a monthly basis for every state dating back to the ACA being signed into law.

For the various enrollment data, I'm using data from Medicaid.gov's Medicaid Enrollment Data Collected Through MBES reports. Unfortunately, they've only published enrollment data through December 2020. In some states I've been able to get more recent enrollment data from state websites and other sources.

Delaware

I've once again relaunched my project from last fall to track Medicaid enrollment (both standard and expansion alike) on a monthly basis for every state dating back to the ACA being signed into law.

For the various enrollment data, I'm using data from Medicaid.gov's Medicaid Enrollment Data Collected Through MBES reports. Unfortunately, they've only published enrollment data through December 2020. In some states I've been able to get more recent enrollment data from state websites and other sources.

Wyoming

March 31st, 2021:

Senate committee kills Medicaid expansion bill, by Morgan Hughes

Medicaid expansion will not happen in Wyoming this year.

The state’s Senate Labor, Health and Social Services Committee killed a bill Wednesday morning to expand the federal insurance program, which would have insured an estimated 25,000 additional Wyomingites.

Lawmakers have defeated similar proposals for nearly a decade. Advocates hoped this year might be different. Many House Republicans voiced a change of heart after the COVID-19 pandemic and the decline of fossil fuels rocked the state’s economy, leaving many without health coverage. This session was the first in which a bill to expand the program passed a legislative chamber.

Medicaid Expansion Map

I ran these numbers last month in my write-up speculating about the prospect of Democrats and the Biden Administration effectively "federalizing" ACA Medicaid expansion altogether by raising the FMAP threshold from 90% to 100%, but it's worth a standalone blog post as well.

The Kaiser Family Foundation estimates that nearly 2.2 million Americans currently fall into the "Medicaid Gap" in the 12 states which haven't expanded Medicaid under the Affordable Care Act yet. They also estimate that another 1.8 million uninsured Americans are eligible for subsidized ACA exchange plans who would be eligible for Medicaid instead if those state actually did expand Medicaid. That's nearly 4.0 million total.

Florida

As I noted recently, I've relaunched my project from last fall to track Medicaid enrollment (both standard and expansion alike) on a monthly basis for every state dating back to the ACA being signed into law.

For total monthly Medicaid enrollment, the official Medicaid.gov monthly enrollment data is only available dating back to late 2013, and it's only current through November 2020. The Kaiser Family Foundation has also compiled the pre-2014 average enrollment for each state based on the 3rd quarter of 2013. In some states I've been able to find more recent enrollment data for December 2020 or later.

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