Medicaid Expansion

2018 MIDTERM ELECTION

Time: D H M S

Every month I post an entry about the official CMS Medicaid enrollment report, documenting the increase in Medicaid enrollment since ACA expansion went into effect. The numbers were increasing dramatically every month for nearly two years, but started slowing down last fall as most of the expansion states started maxing out on their eligible enrollees.

As of July 2016, total Medicaid enrollment continued to quietly increase for a total of 72.8 million people, with 15.4 million of that being mainly due to the ACA (~10 million via official expansion, ~1 million early additions/transfers and ~4 million "woodworkers").

Regular readers know that I used to regularly post an entry about the official CMS Medicaid enrollment reports every month, documenting the increase in Medicaid enrollment since ACA expansion went into effect. The numbers were increasing dramatically every month for nearly two years, but started slowing down last fall as most of the expansion states started maxing out on their eligible enrollees.

As of November 2015, there had been a net increase of 14.1 million people added to the Medicaid rolls since October 2013 (the month when ACA expansion enrollment began), plus another 950,000 people who had already been quietly transferred over to Medicaid from existing, state-funded programs prior to 2013 via other ACA provisions. I sort of forgot to post about the reports for awhile, but checked back in again for the May report, released back in July.

A quickie: Just 5 days ago it was reported that...

As of the beginning of August265,723 low-income Louisianians have newly signed up for Medicaid, according to state officials.

Well, according to NOLA reporter Kevin Litten just now...

INBOX: Medicaid expansion in Louisiana topped 278,000 people on Wednesday. That leaves about 100k people to sign up to hit goal by 2017.

— Kevin Litten (@kevinlitten) August 10, 2016

That's a net increase of 12,277 people in just 9 days, or over 1,300 per day.

There are an estimated 375,000 Louisianans eligible for ACA Medicaid expansion. If they can enroll another 700/day, they'll have maxed out by New Year's Eve.

I'm finally taking a break for my final batch of 2017 Rate Request states to focus on some good news out of Louisiana:

Patients burst into tears at this city’s glistening new charity hospital when they learned they could get Medicaid health insurance.

In Baton Rouge, state officials had to bring in extra workers to process the flood of applications for coverage.

And at the call center for one of Louisiana’s private Medicaid plans, operators recorded their busiest day on record.

The outpouring began in June, when Louisiana became the 31st state to offer expanded Medicaid coverage through the Affordable Care Act, effectively guaranteeing health insurance to its residents for the first time.

Now, as Republican presidential nominee Donald Trump promises to repeal the healthcare law, Louisiana is emerging as a powerful illustration of the huge pent-up demand for health insurance, particularly in red states where elected officials have fought the 2010 law.

Supreme Court grants emergency order to block transgender male student in Virginia from using boys' restroom

Almost exactly 1 year ago, both Andrew Sprung and I realized that due to an overlap in two provisions of the ACA, a significant chunk of exchange enrollees would actually be eligible for Medicaid instead of a private QHP...if the remaining Republican holdout states were to stop being jackasses and expand the program already.

Why? Because while ACA Medicaid expansion covers people up to 138% of the Federal Poverty Line, QHP financial assistance applies to those with incomes between 100-400% of the FPL. In other words, anyone enrolled in a private exchange policy between 100-138% FPL in a NON-expansion state would automatically become eligible for Medicaid instead the moment that state expanded their Medicaid program via the ACA.

Unfortunately, there was no way of knowing exactly how many people this applied to, because until now, the HHS Dept. only broke out exchange enrollee income brackets into 50% chunks (ie, they listed 100-150% FPL, but not 100-138%).

A few weeks ago I noted that thanks to the election of Democratic Governor John Bel Edwards (with an assist by David Vitter's diaper fetish), up to 375,000 lower-income Louisiana residents became eligible for the ACA's Medicaid expansion provision starting a month earlier than expected (June 1st instead of July 1st).

Enrollment officially started early this morning (not sure if it was right at midnight or if they had to wait until the state offices opened or whatever), and as of around 11:40am...

Gov. Edwards announces that there are already 175,000 Louisianans enrolled in the expanded Medicaid program. #lagov #lalege

— Gov John Bel Edwards (@LouisianaGov) June 1, 2016

Holy Smokes.

Ever since Medicaid expansion officially kicked off in January 2014, the program's enrollment tally started swelling by hundreds of thousands of people every month, and continued to do so right up until July of this year, when it petered out completely:

28,524 additional people were enrolled in July 2015 as compared to June 2015 in the 51 states that reported comparable July and June 2015 data.

Yes, that's right: The net total number of Medicaid/CHIP enrollees went up fewer than 30,000 people in July.

It's worth noting that the improving economy may be a significant part of this. Remember that this is the net number of enrollees; for all I know, 300,000 new people joined the program but 270,000 who were already on it left. Baseline churn is tricky to keep track of.

However, the more likely cause is far simpler: ACA Medicaid expansion has simply finally maxed out in most of the states allowing it, and most of the "woodworker" crowd has presumably finally figured out that they're eligible as well.

Every month the CMS division of the HHS Dept. issues a formal Medicaid/CHIP enrollment report, and pretty much every month (until now) the numbers have grown rapidly. This has been the case even during the "off-season", since there isn't an off season for Medicaid/CHIP enrollment; those eligible for the programs can enroll year-round (on the other hand, promotion/outreach efforts are higher during Open Enrollment, so enrollment does still tend to be more rapid during that period).

As of the end of June, this trend was still continuing: While not hitting the half-million plus rates of many earlier months, nearly 300,000 more people still signed up in June.

292,112 additional people were enrolled in June 2015 as compared to May 2015 in the 51 states that reported comparable June and May 2015 data.

With South Dakota's DAKOTACARE dropping off the ACA exchange and asking for 63% rate hikes, this (potential) development can't come soon enough:

South Dakota may join 30 other states in expanding its Medicaid program if federal officials approve a plan Gov. Dennis Daugaard is set to outline to the nation’s top health and human services administrator in Washington on Tuesday.

The Republican governor is meeting with Health and Human Services Secretary Sylvia Burwell to explain the plan, and the federal government has so far been more open to discussions than in the past, said Tony Venhuizen, chief of staff to Daugaard. The proposal, which is in its early stages, would make about 48,500 South Dakota residents newly eligible for the program.

The twist this time is that the Indian Health Service, which provides healthcare coverage for around 2 million Native Americans nationally, would be involved:

 

(repost from 2015)

There's not one, not two, not three but four articles I'm reading this morning centering around the same theme: GOP governors who are finally starting to at least consider expanding Medicaid under the Affordable Care Act, but only if the enrollees jump through various hoops in order to qualify:

Sarah Wheaton, Politico:

In nearly a dozen Republican-dominated states, either the governor or conservative legislators are seeking to add work requirements to Obamacare Medicaid expansion, much like an earlier generation pushed for welfare to work.

The move presents a politically acceptable way for conservative states to accept the billions of federal dollars available under Obamacare, bringing health care coverage to millions of low-income people. But to the Obama administration, a work requirement is a non-starter, an unacceptable ideological shift in the 50-year-old Medicaid program and a break with the Affordable Care Act’s mission of expanding health care coverage to all Americans. The Health and Human Services Department has rejected all requests by states to tie Medicaid to work.

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