CMS releases June 2023 enrollment data: Medicaid/CHIP enrollment dropped another 1.2 million as #MedicaidUnwinding ramped up

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

In June 2023, 92,614,205 individuals were enrolled in Medicaid and CHIP.

  • 85,614,581 individuals were enrolled in Medicaid in June 2023, a decrease of 1,169,095 individuals (1.3%) from May 2023.
  • 6,999,624 individuals were enrolled in CHIP in June 2023, a decrease of 32,449 individuals (0.5%) from May 2023.
  • As of June 2023, enrollment in Medicaid and CHIP has decreased by 1,304,004 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 decreased by 1,175,034 individuals (1.4%).
    • CHIP enrollment has decreased by 128,970 individuals (1.8%).
  • Between February 2020 and March 2023, enrollment in Medicaid and CHIP increased by 23,043,140 individuals (32.5%) to 93,918,209
    • Medicaid enrollment increased by 22,709,822 individuals (35.4%).
    • CHIP enrollment increased by 333,318 individuals (4.9%).

June was the month when the long-expected "Medicaid Unwinding" process really started to ramp up. 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.

According to KFF's Medicaid Unwinding tracker, at least 7.87 million people have lost Medicaid/CHIP coverage since last spring; those numbers will continue to be reflected in the official CMS Medicaid enrollment reports over the coming months.

On the upside, according to a different report via the HHS Dept, 410,000 of those who had lost Medicaid/CHIP coverage due to the unwinding process as of the end of June went on to enroll in either an ACA exchange policy or a Basic Health Plan policy (MN/NY only).

While this isn't an exact comparison (Medicaid/CHIP have high churn rates from month to month), it does suggest that a significant portion of those who are losing coverage are being shifted over to ACA plans instead...potentially up to 31% of the total as of the end of June, anyway.

If (and this is a pretty big assumption) that rate were to hold true in the later months, that would mean over 2.4 million members of the Unwinding population have moved to ACA plans, which would be huge.

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 June 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 June 2023 was likely around 94.2 million nationally.