Hawaii: Medicaid expansion enrollment up 37% since COVID hit; total Medicaid up 21%


I've once again relaunched my project from last fall to track Medicaid enrollment (both standard and expansion alike) on a monthly basis for every state dating back to the ACA being signed into law.

For the various enrollment data, I'm using data from Medicaid.gov's Medicaid Enrollment Data Collected Through MBES reports. Unfortunately, they've only published enrollment data through December 2020. In some states I've been able to get more recent enrollment data from state websites and other sources.

Today I'm presenting Hawaii. Hawaii is one of the few states where the number of Medicaid expansion enrollees who had already been eligible for the program prior to ACA expansion is greater than the number who were only made eligible due to ACA expansion. For "previously-eligibles" I the main distinction is what portion of the cost of the program is paid for by the state vs. the federal government, although enrollment among this population still increased dramatically thanks to the various streamlining provisions of the ACA, as well as the increased eligibility awareness & outreach. The data for Jan - March 2020 are adjusted estimates via the Hawaii DHS.

Total Medicaid enrollment in Hawaii ranged around 320K for years until the COVID pandemic hit in February 2020. Since then, non-ACA Medicaid enrollment has climbed at least 11.5% and ACA expansion enrollment has increased by 37.3%, for an overall increase of 20.8% over the pre-COVID era as of March 2021.

Hawaii has 1,455,271 residents. As of March 2021:

  • 371,000 are enrolled in Medicaid overall, or 25.5% of the population
  • 220,000 were enrolled in non-ACA Medicaid
  • 151,000 were enrolled in Medicaid expansion.
    • Around 124,000 of these were already eligible for Medicaid prior to the ACA, but that wouldn't matter much if the Supreme Court strikes down the law, since whatever state funding programs were in place back in 2013 have almost certainly long since been discontinued or been reallocated towards other state services. All 151,000 would likely be screwed.
  • Add in the ~19,000 subsidized ACA exchange enrollees and that's around 171,000 Hawaii residents who would lose healthcare coverage if the Supreme Court strikes down the Affordable Care Act, or 11.8% of the state population.