California: Current Medicaid enrollment 500K higher than previously thought!

Hat Tip To: 
Chad Terhune, Chris Megerian

LA Times reporter Chris Megerian has posted an important story about California's looming healthcare budget crisis. It mostly deals with the headaches facing the state budget as it tackles major increases in both Medi-Cal (CA's name for Medicaid) and the cost of caring for public employee retirees, and is a good read for healthcare/budget wonks.

What caught my eye, however, was this line about halfway through:

Over the next year, total Medi-Cal enrollment is expected to reach 12.2 million, he said — about one-third of the state's population. It was less than 8 million in 2013.

Hmmm...that sounds a bit high to me, so I ran the numbers against my own current estimates and came up with the following:

  • 1. "less than 8 million" to start 2014 (call it 7.9 million)
  • 2. Newly-eligible via ACA Expansion: 2.25 million
  • 3. Previously-eligible but not enrolled before (Woodworkers): 565K
  • 4. LIHP Transferees: 650K
  • 5. Newly-eligible (traditional Medicaid rules): Unknown...perhaps 100K??
  • Total: 11.465 million or so

In order to reach 12.2 million, that would mean CA would have to add another 735,000 people this year, via a combination of #2, 3 and 5 above.

I contacted Mr. Megerian and asked him about this:

Huh. So, this means that CA's current Medicaid enrollment is a whopping 510,000 people higher than they had previously estimated, meaning they expect to add "only" another quarter-million or so this year.

There's no breakout of that 500K figure, of course. According to the Kaiser Family Foundation's estimates from last fall, CA started the year with roughly 2.98 million people eligible for Medi-Cal or CHIP (either via expansion or "woodworker" status), and the 2.81 million combined total that I have so far is only around 170,000 away from that cap (remember, the 650K transferred from LIHP don't "count" as "uninsured" at the time since they were in an existing program...although that program itself was also enabled by the ACA as well).

Of course, these are all rounded figures, and the KFF estimate was just that; the actual number eligible could be a couple hundred thousand higher or lower. However, assuming that they had it right, that suggests a breakout of something along the lines of:

  • 100K (?) additional via expansion
  • 50K (?) additional "woodworkers"
  • 360K (?) additional who were newly eligible under traditional Medicaid rules

That would effectively max out the ACA expansion/woodworker pool...except that Megerian says that they're still expecting another 230,000 to be added this year on top of all of that! Good heavens.

Anyway, unless/until someone has more solid numbers, I'm going to bump up my CA Medicaid estimates as follows:

  • Strict Expansion: From 2.25M to 2.35M
  • Woodworkers: From 565K to 615K

There's also the matter of CA's formerly-massive Medi-Cal backlog, which had been whittled down to "under 100K" last I heard. I presume they've made further progress since then, but am not sure how to enter that so I'll leave it be for now.