Maryland: Net QHP attrition finally kicks in but Medicaid expansion continues to boom

When I posted Maryland's July enrollment update, I noted that the effectuated exchange-based QHP number had actually gone up slightly from April through July (from 125,535 to 126,346). Not much of an increase, of course, but the fact that this number increased at all was significant since it indicated that, as I expected, new additions to the exchange QHP pool thanks to the "life event" options are slightly outpacing those dropping their policies during the off-season.

Last week the MD HealthBenefit Exchange released their August report and, as I've also been expecting, the tide is now starting to turn, with "drop-outs" finally starting to outpace the new additions:

BALTIMORE (Aug. 18, 2015) -- As of Aug. 13th, 606,226 Marylanders have enrolled in quality, affordable health coverage for 2015 through Maryland’s state-based insurance marketplace.

That includes 123,673 people enrolled in private Qualified Health Plans (QHP) and 482,553 people enrolled in Medicaid through the marketplace since open enrollment for the year began on Nov. 15, 2014. Nearly 94 percent of all Marylanders who have enrolled through Maryland Health Connection for coverage this year received financial assistance.

The QHP total includes 5,436 people who enrolled during a tax season Special Enrollment Period from March 15 through April 30. Marylanders who owed a tax penalty because they did not have health coverage in 2014 were allowed to enroll for 2015 coverage after open enrollment ended. Of those enrollments, 1,539 were in the 18-34 year-old age group; 2,487 were 35-54, and 1,410 were in the 55+ age group.

As I noted last month, the "94% receiving financial assistance" bit is slightly misleading; it's true, but only because the Medicaid enrollees are lumped in. If you're talking about QHPs only, it's more like 71% (87.3K out of 123.7K). Whether that's a good or bad thing obviously depends on your POV.

The larger point is that aside from the 11,000 or so people who never paid their first premium at all (effectuated enrollment as of 3/31/15 was 114,559 while QHP selections during Open Enrollment + the Tax Season SEP totalled 125,581), Maryland has seen virtually no net attrition so far. This will likely change towards the end of the year, but for now it's good news.

Meanwhile, on the Medicaid side:

As of July 31, the total number of Medicaid and MCHP enrollment is 1,237,142. Compared to Dec. 31, 2013, the net change in Medicaid enrollment as of July 31, 2015 is +234,285. This figure takes into account that individuals lose Medicaid coverage because of changes in household, age and income, as well as redeterminations. Also, the total number of ACA Medicaid Expansion Adults is 220,026 as of July 31. That is newly eligible childless adults up to 138 percent of the Federal Poverty Level (FPL) and newly eligible parents 116 percent to 138 percent FPL.

As explained in the press release, it's important to remember that the 482,553 figure is the cumulative number of new Medicaid enrollees; current enrollees have also dropped out of the program (just as some people have dropped their private plans), leaving a net increase of 234,285.

Maryland is also one of the few states to break out actual ACA Medicaid expansion from "woodworkers": 220,026 of the former vs. just 14,259 of the latter.

In addition, this report breaks out MD ACA exchange enrollment by both Metal Level and Market Share: