CMS releases May 2023 enrollment data: Medicaid/CHIP enrollment dropped for first time from peak enrollment as #MedicaidUnwinding kicked in

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

In May 2023, 93,815,749 individuals were enrolled in Medicaid and CHIP.

• 86,783,676 individuals were enrolled in Medicaid in May 2023, a decrease of 279,373 individuals (-0.3%) from April 2023.

• 7,032,073 individuals were enrolled in CHIP in May 2023, a decrease of 41,687 individuals (0.6%) from April 2023

• As of May 2023, enrollment in Medicaid and CHIP has decreased by 61,085 since March 2023, the final month of the Medicaid continuous enrollment condition under the Families First Coronavirus Response Act (FFCRA) and amended by the Consolidated Appropriations Act, 2023.
  • Medicaid enrollment has increased by 69,102 individuals (0.1%).
  • CHIP enrollment has decreased by 130,187 individuals (1.8%)

• Between February 2020 and March 2023, enrollment in Medicaid and CHIP increased by 23,001,765 individuals (32.5%) to 93,876,834.
  • Medicaid enrollment increased by 22,634,781 individuals (35.3%).
  • CHIP enrollment increased by 366,984 individuals (5.4%)

May was the first month that the long-expected "Medicaid Unwinding" process resulted in a total enrollment drop. While the continuous coverage provision ended on March 31st, enrollment in Medicaid actually continued to increase for one month more in April, to an all-time high of 94.1 million Americans.

While the net drop in May 2023 was fairly nominal compared to March, it was more significant versus that April high (nearly 280,000 people nationally)...and that was just the beginning. According to KFF's Medicaid Unwinding tracker, over 5.5 million people have lost Medicaid/CHIP coverage since last spring; those numbers will be reflected in the official CMS Medicaid enrollment reports over the coming months.

One important caveat: As always, 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:

• The MBES report is 9 months out of date (through December 2022) while the Trend Snapshot is only 4 months outdated (through May 2023).

• 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 MBES report put the grand total of Medicaid/CHIP enrollees nationally at 98.8 million as of December 2022, but again, the different definitions make this a bit fuzzy.

The MBES numbers for U.S. territories stood at 1.63 million Medicaid enrollees as of December 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 May 2023 was likely around 96 million nationally.