CMS releases April 2023 enrollment data: Medicaid/CHIP enrollment peaked at 94.1M (actually more like 95.7M w/U.S. territories) as #MedicaidUnwinding kicked in

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

In April 2023, 94,151,768 individuals were enrolled in Medicaid and CHIP.

  • 87,062,629 individuals were enrolled in Medicaid in April 2023, an increase of 348,055 individuals from March 2023.
  • 7,089,139​​​​​​​ individuals were enrolled in CHIP in April 2023, a decrease of 73,121 individuals from March 2023.
  • Since February 2020, enrollment in Medicaid and CHIP has increased by 23,276,699 individuals (32.8%).
    • Medicaid enrollment has increased by 22,982,836 individuals (35.9%).
    • CHIP enrollment has increased by 293,863 individuals (4.3%).

Medicaid enrollment likely increased due to the COVID-19 PHE and Medicaid continuous enrollment condition under the Families First Coronavirus Response Act (FFCRA), which started in March 2020 and ended on March 31, 2023.

  • In April 2023, 2,329,772 applications for Medicaid and CHIP were submitted directly to states.
    • The number of applications submitted directly to states was 0.7 percent lower in April 2023 compared to March 2023.
  • In April 2023, 152,684 applications were transferred from the Federally Facilitated Marketplace (FFM) to states.
    • The number of transferred applications was 12.6 percent lower in April 2023 compared to March 2023.

However, it's important to note that 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 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 April 2023 was likely around 95.7 million nationally.

April 2023 was likely to be the high water mark for Medicaid/CHIP enrollment for some time to come, due to the continuous coverage requirement ending as of the end of March. Since April, over 3.7 million Americans have been disenrolled from the program, and that number is expected to increase dramatically over the coming months.