CMS releases Jan. 2023 enrollment data: Medicaid/CHIP enrollment officially breaks 93M (likely ~95.6M as of March w/U.S. territories)

via the Centers for Medicare & Medicaid Services (CMS):

In January 2023, 93,008,246 individuals were enrolled in Medicaid and CHIP.

  • 85,915,795 individuals were enrolled in Medicaid in January 2023, an increase of 629,200 individuals from December 2022.
  • 7,092,451 individuals were enrolled in CHIP in January 2023, an increase of 30,891 individuals from December 2022.
  • Since February 2020, enrollment in Medicaid and CHIP has increased by 22,358,006 individuals (31.6%).
    • Medicaid enrollment has increased by 22,110,705 individuals (34.7%).
    • CHIP enrollment has increased by 247,301 individuals (3.6%).

The Medicaid enrollment increases are likely driven by COVID-19 and the continuous enrollment condition in the Families First Coronavirus Response Act (FFCRA).

  • In January 2023, 2,497,172 applications for Medicaid and CHIP were submitted directly to states.
    • The number of applications submitted directly to states was 5.8 percent higher in January 2023 compared to December 2022.
  • In January 2023, 292,420 applications were transferred from the Federally Facilitated Marketplace (FFM) to states.
    • The number of transferred applications was 50 percent lower in January 2023 compared to December 2022.

As an aside, when I posted my "Psychedelic Donut" breakout of healthcare coverage of the entire U.S. population as of January 2023 in February, I noted:

While the pending end of the COVID pandemic Continuous Coverage requirement is about to lead to a massive Medicaid "Unwinding" starting in April, as of this moment I'm assuming that total Medicaid/CHIP enrollment has gone up by at least another million since October.

Well, sure enough, it went up 444,000 from October to November, 425,000 more from November to December, and 629,000 more from December to January. That's actually around 1.5 million more enrollees.

Assuming Medicaid/CHIP enrollment increased another ~500K or so in February and March--just prior to the "Medicaid Unwinding" period--that would put the total at around 94 million as of the end of March. Since April 1st, however, enrollment has started to drop off via the Unwinding process.

However, there's more: CMS actually has two different reports on Medicaid enrollment: The monthly Medicaid & CHIP Enrollment Trend Snapshot (referenced above) and the Medicaid Budget & Expenditure System (MBES).

Each type of report includes some data that the other doesn't, but each also measures Medicaid enrollment a bit differently:

  • Trend Snapshots are more up to date (through January 2023 instead of September 2022)
  • The MBES count includes individuals enrolled in limited benefit plans and the Performance Indicator count does not include such individuals.
  • The MBES data represents the count of unduplicated individuals enrolled in the state’s Medicaid program at any time during each month in the quarterly reporting period, while the Performance Indicator data captures the count of individuals enrolled on the last day of the month.
  • The MBES count only includes individuals whose coverage is funded through Medicaid (title XIX of the Social Security Act), while the published Performance Indicator also includes individuals funded through CHIP (title XXI of the SSA).
  • MBES and Performance Indicator data may be derived from different state systems.
  • Retroactive state adjustments to MBES or Performance Indicator data may be in progress.
  • States have likely generated MBES data and Performance Indicator data from state systems on different dates.
  • The other major difference: The MBES reports include Medicaid enrollees in the U.S. territories: American Samoa, Guam, N. Mariana Islands, Puerto Rico and the U.S. Virgin Islands.

Some of these actually cancel each other out: Some are higher in the Trend Snapshot reports while others are higher in the MBES counts. In fact, the September 2022 MBES report puts the grand total of Medicaid/CHIP enrollees nationally at 96.0 million, but again, the different definitions make this a bit fuzzy.

The MBES numbers for U.S. territories only stood at 1.61 million Medicaid enrollees as of September 2022.

When I use the lower "Trend Snapshot" totals for the 50 states + DC and the MBES numbers for the territories only, along with the likely increases in the U.S. states & DC since January, the grand total of Medicaid/CHIP enrollment as of March was likely around 95.6 million nationally.

This was likely the high water mark for Medicaid enrollment historically, and will likely remain that way for quite some time unless there's another pandemic which causes "continuous coverage" to be reinstated, the remaining ten non-expansion states all go ahead and expand the program or some other major policy shift occurs.