So how many Medicaid enrollees ARE new vs. renewals, anyway?

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 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 :)

In any event, the other huge question beyond the actual number of enrollees is how many of them are new to Medicaid/CHIP as opposed to simply being re-enrollments of existing recipients? Unfortunately, neither the HHS nor the CMS reports separate these out, so it's impossible to know what this number nationally yet.

However, there is one state (Washington) which does separate them out. It isn't much, but at least it's something:

  • Medicaid Newly Eligible Adults: 134,700
  • Medicaid Previously Eligible but not Enrolled: 63,070
  • Medicaid Redeterminations (Previously Covered): 183,141

So, out of a total of 381K Medicaid enrollees, about 48% of them were already on Medicaid prior to October 1st anyway.

First, I should note that I'm not including Washington State's "redetermination" (renewal) number in the spreadsheet, so for at least one state this is a "clean" number.

Second: Yes, I am including the "previously eligible but not enrolled" figure. While there were obviously a certain number of people who are always enrolling in Medicaid every month prior to the ACA, there's ample evidence that publicity about the ACA and the exchanges has sparked large increases in Medicaid enrollment by people who simply didn't know that they were already qualified before the ACA, even in states which didn't expand the program. Those people should certainly count as being "enrolled thanks to the ACA" by my standards.

Third, I should stress that Washington State is not necessarily representative of the Medicaid situation in the other 49 states (+DC). There are wildly varying socioeconomic conditions, different state laws for Medicaid programs and enrollment procedures, and of course many states didn't implement the ACA's Medicaid expansion rules at all.

HOWEVER, if this does prove to be representative nationally, that suggests that the number of new Medicaid enrollees since the ACA exchanges were launched and the expansion rules went into effect would be in the range of 2.2 million to 3.1 million.

Until we can separate out the numbers in a bunch of other states, however, this remains pretty speculative.

UPDATE: Well, this is interesting. Just hours after I posted this entry, several states released updated numbers, and 2 of them (Colorado & Maryland) included information many are redeterminations/reenrollments. Colorado clearly stated that their Medicaid numbers don't include them, while Maryland was a bit more confusingly worded but seemed to indicate a drop of 13,000 from the HHS tally due to those being reenrollments.

So, as far as I can tell, 3 out of 51 states (+DC) are now giving "clean" Medicaid numbers.