CMS releases December 2023 enrollment data: Medicaid/CHIP enrollment dropped another 785,000 as Medicaid Unwinding continued

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

• In December 2023, 85,094,448 individuals were enrolled in Medicaid and CHIP, a decrease of 785,863 individuals (0.9%) from November 2023
  • 77,913,798 individuals were enrolled in Medicaid in December 2023, a decrease of 786,068 individuals (1.0%) from November 2023.
  • 7,180,650 individuals were enrolled in CHIP in December 2023, an increase of 205 individuals (0.0%) from November 2023.

• As of December 2023, enrollment in Medicaid and CHIP has decreased by 8,773,558 individuals (9.3%) 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 8,816,761 individuals (10.2%).
  • CHIP enrollment has increased by 43,203 individuals (0.6%).
• Between February 2020 and March 2023, enrollment in Medicaid and CHIP increased by 22,992,937 individuals (32.4%) to 93,868,006.
  • Medicaid enrollment increased by 22,6350,766 individuals (35.3%).
  • CHIP enrollment increased by 342,171 individuals (5.0%).

While the continuous coverage provision ended on March 31st, 2023 (one year ago), 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 19.1 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 next few months.

On the upside, according to a different report via the HHS Dept, nearly 3.7 million of those who had lost Medicaid/CHIP coverage due to the unwinding process as of the end of December went on to enroll in either an ACA exchange policy or a Basic Health Plan policy (MN/NY). This represents 26.7% of the total "Unwinding" population through the end of 2023.

Another 3% or so were found likely eligible for Medicaid/CHIP after all; presumably the vast bulk of them have since re-enrolled in those programs. The fate of the remaining ~70% or so is unknown, however.

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 6 months out of date (through June 2023) while the Trend Snapshot is only 3 months outdated (through September 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 98.3 million as of June 2023, but again, the different definitions make this a bit fuzzy.

The MBES numbers for U.S. territories stood at 1.64 million Medicaid enrollees as of June 2023. If you add those to the Trend Snapshot total for the 50 states +DC, it comes in at 86.7 million as of December 2023.

It's also worth noting that ACA Medicaid Expansion enrollment specifically  was 23.2 million as of September 2023 according to preliminary data from a report by the Assistant Secretary for Planning & Evaluation (ASPE) last week. This puts total ACA Medicaid expansion down by around 1.5 million from the all-time high it reached in May 2023.