Guest Post: Counting ACA Enrollments in California

The December report released Jan. 21 by Covered California shows that from Oct. 1-Dec. 31 the exchange received 1,107,229 electronic applications for health care coverage through both private plans and Medi-Cal. Multiplying that number by 1.8, "based on an average of 1.8 individuals per application," it was estimated that the number of applications represented 1,993,012 individuals.

The 1.8 factor was not used for "completed applications." From Oct. 1-Dec. 31, there were 771,008 completed applications for health care coverage through Covered California (including Medi-Cal) for 1,456,909 individuals. If the 771,008 completed applications had been multiplied by 1.8, there would have been only 1,387,814 individuals. This indicates that individuals, not households, were counted in the completed applications.

From Oct. 1-Dec. 31, there were 500,108 enrollments in a Covered California health plan (this did not include Medi-Cal). Of the 730,449 individuals who were "determined to be eligible for enrollment in Covered California", more than 2/3 enrolled. Clearly these were enrollments by individuals, not households.

Regarding new enrollees in Medi-Cal, the Covered California report says 405,000 Medi-Cal applicants in December were found likely eligible for coverage - "far more than the 108,000 during November. For the three-month period October-December, a total of 584,000 applicants were determined to be likely eligible for Medi-Cal through the enrollment portal." These people applied through the exchange ("the enrollment portal") rather than at social service offices in 58 counties.

Another December report, this one from the Centers for Medicare and Medicaid Services (CMS), states that "the unit of measurement is a count of individuals (as compared to the application numbers, which may include multiple people in one application)." However, while "the unit of measurement is people with determinations completed, this is not an unduplicated number of unique individuals because an individual may have more than one determination within the reporting period."

To summarize, the 1.8 factor is used to estimate the number of people involved in an application, but in its reports to the Centers for Medicare and Medicaid Services (CMS), California counts individuals.