CMS releases August 2024 Medicaid/CHIP report: Enrollment drops to 79.4M as dust settles on Unwinding process

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

August 2024 Key Findings

Medicaid and CHIP Enrollment

• In August 2024, 79.4 million individuals were enrolled in Medicaid and CHIP.
  • 72.3 million individuals were enrolled in Medicaid, and 7.2 million individuals were enrolled in CHIP.
  • 41.8 million adults were enrolled in Medicaid, and there were 37.6 million Medicaid child and CHIP enrollees.

Medicaid and CHIP Applications Received

• In August 2024, Medicaid, CHIP, Human Services agencies, and State-based Marketplaces received 2.6 million applications, or 19 percent more applications, as compared to July 2024.
• The number of applications received has increased by 22 percent since August 2023 and increased by 62 percent since August 2022.

It's important to note that the August Medicaid/CHIP report has a different look, feel & layout from the previous monthly reports...and, strikingly, is the first monthly report which doesn't lead with references to the 18-month long post-COVID Public Health Emergency "Continuous Coverage/Medicaid Unwinding" process, which is essentially over now.

Having said that, total Medicaid/CHIP enrollment in August 2024 still dropped slightly from July...by around 120,000 people, a far cry from the million-plus enrollees the programs were losing each month for much of the Unwinding period

The all-time high enrollment watermark for Medicaid/CHIP was in April 2023, when it officially hit 94.1 million Americans (possibly as high as 95.7 million if you include the U.S. territories).

From April 2023 through July 2024, net Medicaid/CHIP enrollment dropped by over 14.5 million people, mostly via the post-COVID pandemic "Unwinding" process which has mostly run its course.

On the upside, according to a different report via the HHS Dept, at least 5.1 million of those who had lost Medicaid/CHIP coverage due to the unwinding process went on to enroll in either an ACA exchange policy or a Basic Health Plan policy (MN/NY). This represents 25% of the total "Unwinding" population through the end of April 2024.

The fate of the remaining 72% 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 9 months out of date (through March 2024) while the Trend Snapshot is only 4 months outdated (through August 2024).

• 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.

The MBES numbers for U.S. territories stood at 1.6 million Medicaid enrollees as of March 2024. If you add those to the Trend Snapshot total for the 50 states +DC, it comes in at 81 million as of August 2024.

It's also worth noting that ACA Medicaid Expansion enrollment specifically  was 21.7 million as of March 2024 according to the MBES report. This puts total ACA Medicaid expansion down by around 3 million from the all-time high it reached in May 2023.