August CMS Report: Net increase of 8.7M + 950K = 9.65M added to Medicaid/CHIP due to ACA

Hat Tip To: 
Adam Goldstein

I'm swamped with my day job at the moment, so I won't be able to do an analysis/breakdown until later, but the August CMS Medicaid/CHIP report has been released, and the major takeaway is that even more people have been enrolled in Medicaid or CHIP programs thanks to the Affordable Care Act than even I had estimated (which is either a good or bad thing depending on your partisan leanings):

The Health Insurance Marketplace, Medicaid, and Children’s Health Insurance Program (CHIP) are critical in ensuring coverage for many individuals. As of August 15, 2014, 7.3 million Americans were enrolled in Marketplace coverage and had paid their premiums. This number represents a snapshot of a point in time, not the cumulative enrollment data from October 2013 through August 2014. 

And today’s Medicaid enrollment report shows even more great news: approximately 8.7 million additional Americans now have coverage through Medicaid and CHIP, many for the very first time.  Medicaid enrollment grew to more than 67.9 million in August 2014, which shows nearly a 15 percent increase over the average monthly enrollment for July through September 2013.

Today’s report shows that while enrollment in states that expanded Medicaid has risen by 22 percent since before open enrollment in the Marketplace began, states that have not expanded reported only a 5 percent increase in enrollment during this same period.  And because enrollment in Medicaid and CHIP happens year-round, more people can continue to gain coverage.

First, remember that this report only runs through the end of August.

My own estimates for net Medicaid/CHIP increases as of August 31st had it down at roughly 9.13 million, which would mean I overestimated the tally by around 5%.

HOWEVER, there's another important tidbit missing. In the actual report itself is this note:

These enrollment counts are in addition to the enrollment increases from the nearly 950,000 individuals who gained coverage as a result of the Affordable Care Act before open enrollment began. Seven states implemented an “early option” to expand Medicaid coverage to adults with incomes up to 133 percent of the FPL between April 1, 2010 and January 1, 2014, using new state plan authority provided by the Affordable Care Act or a demonstration under section 1115 of the Social Security Act building upon that authority.

Yes, that's right: The 950K referred to here refers, for the most part, to things like California's LIHP program, which temporarily moved 650,000 residents into a sort of "holding plan" thanks to provisions in the ACA which allowed them to do so in preparation for the official Medicaid expansion,which didn't start until January 2014.

I include these folks on both the Medicaid spreadsheet and graph (under the "Bulk Transfer" heading), which means that instead of overestimating by 5%, I've actually underestimated by about 6%. This is because you have to add 950,000 to the 8.7 million in the report to get the total number of people who have been added to Medicaid/CHIP thanks to the ACA: 9.65 million as of August 31st.

For the record, as a reminder, I have the current total down as around 10.2 million, but I might have to bump this up even more depending on how things went in September and beyond.

UPDATE: OK, I'm feeling kind of stupid now. Thanks to supporter Lucas Caldwell for reminding me that there's a massive Medicaid backlog which the states have been working their way through; I've mentioned this numerous times and even have 950,000 of them subtracted from the grand total on the spreadsheet.

As far as I can tell, the discrepancy just means that the various states have done a better job of working their way through the backlog than I thought.