Medicaid

Last month I noted that North Carolina's ACA Medicaid expansion initiative, which started in December 2023, had officially enrolled more than 400,000 of the estimated 600,000 NC residents eligible for the program.

I just checked on the official NC Dept. of Health & Human Services Medicaid expansion dashboard, and it says that as of May 3rd, expansion enrollment there was up to 447,498 people.

It will be interesting to see how close to that 600K estimate enrollment ends up being over the next year or so.

Back in February I posted a colorful graph which showed the progress of ACA Medicaid Expansion from January 2014 through June 2023.

The data comes from the Centers for Medicare & Medicaid Services quarterly Medicaid Budget & Expenditure System reports. Unfortunately, the MBES reports only ran through June of last year, so it was missing the last half of the year...which is pretty important since that's when the drop in Medicaid coverage due to the ongoing Unwinding process really started to kick in.

Fortunately, CMS recently updated the MBES data to include the third quarter of 2023, bringing Medicaid enrollment *up through September. It's still 8 months out of date but it's better than nothing.

Note: Medicaid expansion enrollment actually peaked in May 2023 at just shy of 24.8 million, but the graph below only includes 6-month increments (January/June).

As of September 2023, MBES put Medicaid expansion enrollment at 23,225,220 nationally.

No further analysis or comment here; I just think this is a pretty cool graphic...and keep in mind that most of the people represented here would have been utterly screwed from early 2020 - early 2023 without the Affordable Care Act being in place when the pandemic hit.

Click the image for a higher-resolution version; the states are listed on the right-hand side, though they might be difficult to make out (also note that Guam, Puerto Rico and the U.S. Virgin Islands also have a number of ACA expansion enrollees shown):

via the NJ Dept. of Banking & Insurance:

TRENTON — New Jersey Department of Banking and Insurance Acting Commissioner Justin Zimmerman today announced the department will continue and extend a previously announced Special Enrollment Period (SEP) to make it easier for qualified individuals who are no longer eligible for NJ FamilyCare coverage to enroll with Get Covered New Jersey.

As required by federal law, the Department of Human Services restarted eligibility reviews for NJ FamilyCare on April 1, 2023. Those who no longer qualify for NJ FamilyCare because their income is too high may be eligible to obtain health coverage through Get Covered New Jersey and may be able to get help paying for premiums.

The end date of this SEP will be extended from July 31, 2024, to November 30, 2024, which will help more individuals leaving NJ FamilyCare to find quality, affordable health insurance through the start of the next Open Enrollment Period. Any eligible consumer who attests to losing NJ FamilyCare (Medicaid/CHIP) coverage between that same time period will be eligible for the SEP.

A month or so ago I noted that as ugly as the massive number of Americans who've had their Medicaid or CHIP coverage terminated is (nearly 22 million people as of last week, via KFF), there's some important mitigating factors to keep in mind (updated w/latest data):

February 16th:

I strongly suspect that at least one of the remaining holdout states will join the expansion crowd this year, most likely Georgia, Mississippi or Alabama...but it likely will be some state-specific variant as described above. Stay tuned...

...As I noted, however, in all three [states] it's pretty likely they'll go with at least a partially privatized version as Arkansas has instead of a "clean" expansion of Medicaid proper.

February 28th:

BREAKING: The Mississippi House just passed Medicaid expansion by a 96-20 vote.
That's more than enough to overcome a veto from Gov. Tate Reeves.
It now heads to the Senate.

Background: https://t.co/exDyzFAcJX

— Ashton Pittman (@ashtonpittman) February 28, 2024

Normally, states will review (or "redetermine") whether people enrolled in Medicaid or the CHIP program are still eligible to be covered by it on a monthly (or in some cases, quarterly, I believe) basis.

However, the federal Families First Coronavirus Response Act (FFCRA), passed by Congress at the start of the COVID-19 pandemic in March 2020, included a provision requiring state Medicaid programs to keep people enrolled through the end of the Public Health Emergency (PHE). In return, states received higher federal funding to the tune of billions of dollars.

As a result, there are tens of millions of Medicaid/CHIP enrollees who didn't have their eligibility status redetermined for as long as three years.

via the Centers for Medicare & Medicaid Services (CMS):

  • • In January 2024, 84,041,447 individuals were enrolled in Medicaid and CHIP, a decrease of 1,056,384 individuals (1.2%) from December 2023.
    • 76,930,368 individuals were enrolled in Medicaid in January 2024, a decrease of 983,655 individuals (1.3%) from December 2023.
    • 7,111,079 individuals were enrolled in CHIP in January 2024, a decrease of 72,729 individuals (1.0%) from December 2023.
  • As of January 2024, enrollment in Medicaid and CHIP has decreased by 9,826,559 individuals (10.5%) since March 2023, the final month of the Medicaid continuous enrollment condition under the Families First Coronavirus Response Act (FFCRA) and amended by the Consolidated Appropriations Act, 2023.
    • Medicaid enrollment has decreased by 9,800,191 individuals (11.3%).
    • CHIP enrollment has decreased by 26,368 individuals (0.4%).
  • Between February 2020 and March 2023, enrollment in Medicaid and CHIP increased by 22,992,937 individuals (32.4%) to 93,868,006.
    • Medicaid enrollment increased by 22,650,766 individuals (35.3%).
    • CHIP enrollment increased by 342,171 individuals (5.0%).

February 16th:

I strongly suspect that at least one of the remaining holdout states will join the expansion crowd this year, most likely Georgia, Mississippi or Alabama...but it likely will be some state-specific variant as described above. Stay tuned...

...As I noted, however, in all three [states] it's pretty likely they'll go with at least a partially privatized version as Arkansas has instead of a "clean" expansion of Medicaid proper.

February 28th:

BREAKING: The Mississippi House just passed Medicaid expansion by a 96-20 vote.
That's more than enough to overcome a veto from Gov. Tate Reeves.
It now heads to the Senate.

Background: https://t.co/exDyzFAcJX

— Ashton Pittman (@ashtonpittman) February 28, 2024

From the linked article in Pittman's tweet:

According to the latest estimates from KFF, over 20 million Americans have now had their Medicaid or CHIP healthcare coverage terminated since the post-public health emergency "unwinding" process began one year ago:

At least 20,104,000 Medicaid enrollees have been disenrolled as of April 11, 2024, based on the most current data from all 50 states and the District of Columbia. Overall, 31% of people with a completed renewal were disenrolled in reporting states while 69%, or 43.6 million enrollees, had their coverage renewed (one reporting state does not include data on renewed enrollees). Due to varying lags for when states report data, the data reported here undercount the actual number of disenrollments to date.

via North Carolina Governor Roy Cooper:

Today, Governor Cooper announced that more than 400,000 North Carolinians now have access to health care through the state’s Medicaid expansion following record enrollment numbers and a coordinated campaign to enroll North Carolinians across the state.

“So many younger, working people desperately need affordable health insurance and Medicaid Expansion fills the bill for thousands of them and with people all the way through age 64,” said Governor Roy Cooper. “This milestone and the speed at which we’ve reached it shows just how lifechanging Medicaid expansion is for our state and we will continue to get more eligible North Carolinians enrolled.”

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