Charles Gaba's blog

Georgia is one of just ten remaining states which is still holding out on fully expanding Medicaid to all legal residents earning up to 138% of the federal poverty level under the Affordable Care Act. Instead, back in 2019, GOP Georgia Governor Brian Kemp submitted a Section 1115 waiver which included a plan to partially expand Medicaid to some uninsured Georgia residents...except with a work reporting requirement for enrollees attached to it.

The program was called "Georgia Pathways," it was approved by the Trump Administration, and unlike several other states which had work requirement provisions shot down by various judges, Georgia's managed to slip through. It was scheduled to go into effect in 2021 and was supposed to be valid until September 30, 2025 before having to be resubmitted for renewal.

The incoming Biden Administration's HHS Dept. put the kibosh on the work requirement provisions of the program. Georgia successfully challenged the administration and Georgia Pathways went into effect last summer...but is still currently scheduled to sunset next September.

Back in November, I noted that Georgia, one of the ten states STILL refusing to expand Medicaid coverage to hundreds of thousands of low-income residents a decade after they could have done so under the ACA, may finally be coming around...albeit via a rather silly & inefficient method. via the Atlanta Journal-Constitution:

Could Georgia adopt an Arkansas-style Medicaid plan?

Senior Republicans see an opening for a health care overhaul

Key Republicans say they’re open to legislation that would add hundreds of thousands of poor Georgians to the state’s Medicaid rolls — and bring in billions of federal dollars to subsidize it — as part of a compromise to roll back hospital regulations.

New York State of Health

via NY State of Health:

  • Certified Enrollment Assistors Visit Colleges Across New York State
  • New Yorkers Who Enroll by February 15 Will Have Coverage in Place for March 1

ALBANY, N.Y. (February 9, 2024) – NY State of Health, the state’s official health plan Marketplace, today announced an informational college campaign, with events taking place on campuses throughout New York State. Certified enrollment assistors will be visiting schools to talk to students about affordable, quality health insurance through the Marketplace, and help current enrollees renew their coverage. Enrollment for 2024 coverage is currently open for Medicaid, Essential Plan, Child Health Plus, and Qualified Health Plans (QHP). Consumers who enroll by February 15 will have coverage for March 1.

New York State of Health

As I noted last week, while the 2024 ACA Open Enrollment Period ended in most states back on January 15th, and in several more as late as January 31st, there are two remaining states where it's technically still going on: California, which bumped their final Open Enrollment deadline out by an extra 9 days at the last minute on the 31st, and New York, which announced last fall that they're keeping enrollment fully open to anyone all the way out until the end of May, to coincide with the end of the ongoing Medicaid Unwinding process.

via Covered California:

With its open-enrollment period ending on Feb. 9, Covered California announced that a record number of Californians have selected health plans for 2024.

As of Jan. 31, there are 1,784,653 Californians who have chosen a health plan through Covered California for 2024, with 306,382​ new enrollees and 1,478,271 renewing their coverage. The total surpasses the previous high set in 2022.

The increased federal subsidies through the Inflation Reduction Act paired with California’s new cost-sharing reduction program for 2024 helped create the highest number of new sign-ups during an open-enrollment period since 2020. Consumers have until midnight on Feb. 9 to enroll in coverage that would be effective as of Feb. 1.

I just posted a colorful graph which tracked ACA Qualified Health Plan (QHP) enrollment over eleven years of Open Enrollment Periods.

Below I've done the same thing for ACA Medicaid Expansion. The data comes from the Centers for Medicare & Medicaid Services quarterly Medicaid Budget & Expenditure System reports.

*Unfortunately the MBES reports only run through June 2023, so it's missing 6 months of updates (which have likely shown a small drop in ACA Expansion Medicaid enrollees due to the ongoing Unwinding process). It therefore actually only includes 10 1/2 yrs of enrollment data.

Also keep in mind that if the remaining 10 states had expanded Medicaid under the ACA by now, the grand total would have been several million higher.

No further analysis or comment here; I just think this is a pretty cool graphic...and keep in mind that most of the ~24.5 million people represented here would have been utterly screwed from early 2020 - early 2023 without the Affordable Care Act being in place when the pandemic hit. Click the image for a higher-resolution version; the states are listed on the right-hand side, though they might be difficult to make out (also note that Guam, Puerto Rico and the U.S. Virgin Islands also have a number of ACA expansion enrollees shown):

There's still likely up to perhaps ~25,000 or so Qualified Health Plan (QHP) enrollments to be added to the 2024 Open Enrollment Period (OEP) tally from the states which haven't reported their final, post-1/16 enrollments (in fact, CA & NY technically haven't ended theirs yet, but I decided to throw this together today for the hell of it.

The table below charts the first eleven years of ACA Open Enrollment Periods, broken out by state. I've also included Basic Health Plan (BHP) enrollment in Minnesota & New York, the only states where BHP programs have been implemented to date (Oregon is scheduled to launch theirs this summer, I believe).

No further analysis or comment here; I just think this is a pretty cool graphic which demonstrates visually how the ACA has grown over time to become firmly embedded into the U.S. healthcare landscape. Source: CMS Marketplace Open Enrollment Period Public Use Files for 2014 - 2023; CMS Final National Snapshot for 2024.

New York State of Health

Thanks to Louise Norris for catching this one.

This is a bit odd...… earlier today I noted that Covered California is extending their Final 2024 Open enrollment deadline out until January 9th due to a service center issue they had over the past few days. A key thing about this, however, is that they included a formal press release to announce the extension.

By contrast, New York State of Health, also supposed to have a deadline of midnight tonight, just posted the following tweet without any formal press release being emailed or posted on their website. Of this writing there's also no notice posted on the front page website.

Very strange, although perhaps they'll send one out/post a notice tonight or tomorrow morning?

Normally, states will review (or "redetermine") whether people enrolled in Medicaid or the CHIP program are still eligible to be covered by it on a monthly (or in some cases, quarterly, I believe) basis.

However, the federal Families First Coronavirus Response Act (FFCRA), passed by Congress at the start of the COVID-19 pandemic in March 2020, included a provision requiring state Medicaid programs to keep people enrolled through the end of the Public Health Emergency (PHE). In return, states received higher federal funding to the tune of billions of dollars.

As a result, there are tens of millions of Medicaid/CHIP enrollees who didn't have their eligibility status redetermined for as long as three years.

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

  • In October 2023, 87,289,666 individuals were enrolled in Medicaid and CHIP, a decrease of 1,160,543 individuals (1.3%) from September 2023.
    • 80,227,593 individuals were enrolled in Medicaid in October 2023, a decrease of 1,210,160 individuals (1.5%) from September 2023.
    • 7,062,073 individuals were enrolled in CHIP in October 2023, an increase of 49,617 individuals (0.7%) from September 2023.
  • As of October 2023, enrollment in Medicaid and CHIP has decreased by 6,561,074 individuals (7.0%) 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 6,489,844 individuals (7.5%).
    • CHIP enrollment has decreased by 71,230 individuals (1.0%).
  • Between February 2020 and March 2023, enrollment in Medicaid and CHIP increased by 22,975,671 individuals (32.4%) to 93,850,740.
    • Medicaid enrollment increased by 22,637,644 individuals (35.3%).
    • CHIP enrollment increased by 338,027 individuals (5.0%).