Charles Gaba's blog

Back in January, I noted that total enrollment in healthcare policies either specifically created by or expanded to more people by the Affordable Care Act had broken 40 million Americans:

With last week's report from the Centers for Medicare & Medicaid Services (CMS) touting the record-breaking 16.3 million Qualified Health Plan (QHP) selections during the 2023 Open Enrollment Period (OEP), it's time to take another look at the grand total.

For this, I'm assuming a similar 94% average effectuation rate as of February 1st (2 days from now) to the ASPE report from last year for QHP enrollees. Taken literally, that would mean 15,328,061 effectuated on-exchange ACA enrollees.

Every month for years now, the Centers for Medicare & Medicare Services (CMS) has published a monthly press release with a breakout of total Medicare, Medicaid & CHIP enrollment; the most recent one was posted in late February, and ran through November 2022.

Since December 2022, however, they haven't sent out the normal press release; instead, they included a brief note leading to a Medicaid/CHIP data slideshow , along with another note leading to their new Medicare Monthly Enrollment database.

In any event, according to the spreadsheet I exported, as of January 2023:

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

In January 2023, 93,008,246 individuals were enrolled in Medicaid and CHIP.

• 85,915,795 individuals were enrolled in Medicaid in January 2023, an increase of 629,200 individuals from December 2022.

• 7,092,451 individuals were enrolled in CHIP in January 2023, an increase of 30,891 individuals from December 2022.

• Since February 2020, enrollment in Medicaid and CHIP has increased by 22,358,006 individuals (31.6%).
  • Medicaid enrollment has increased by 22,110,705 individuals (34.7%).
  • CHIP enrollment has increased by 247,301 individuals (3.6%).

The Medicaid enrollment increases are likely driven by COVID-19 and the continuous enrollment condition in the Families First Coronavirus Response Act (FFCRA).

About a year ago, I noted that the state of Oregon had passed a bill which, if the federal waiver is approved by the federal government, would make them the third state in the U.S. to establish a Basic Health Plan program under the Affordable Care Act. As reported by Megan Messerly of Politico at the time:

In Oregon, Democrats passed a bill in March to establish a basic health program, the details of which are being ironed out by a task force that began meeting this week. In Kentucky, Republicans approved $4.5 million in state funds this spring to set up a basic health program, which was signed into law by the state’s Democratic governor. An estimated 85,000 Oregonians and at least 37,000 Kentuckians will be eligible to enroll in the plans as soon as next year.

via NY State of Health:

• Enrollment Assistors Attend YMCA Kids Day Events Throughout the State to Help Consumers Renew or Enroll in Health Coverage

• Eligibility Redeterminations will be Resuming for Over 9 Million New Yorkers in Medicaid, Child Health Plus and the Essential Plan  

ALBANY, N.Y. (April 27, 2023) – NY State of Health, the state’s official health plan Marketplace, today announced it will participate in the YMCA’s annual Healthy Kids Day, a national initiative featuring free community events with family-friendly activities that promote wellness. Certified enrollment assistors will be available at select YMCAs statewide on April 29, 2023, to provide free help to New Yorkers. They will provide information about upcoming changes to their health insurance, answer questions about renewals, and provide information to uninsured New Yorkers about enrolling in coverage through the Marketplace.  

via the Centers for Medicare & Medicaid Services:

CMS Approves of State of Washington Medicaid Section 1115 Demonstration

April 14: CMS approved an amendment to the State of Washington's Medicaid section 1115(a) demonstration, titled “Medicaid Transformation Project." Approval of this demonstration amendment includes several improvements, like historic continuous eligibility for Medicaid children from the point they become eligible until they reach age six, regardless of income fluctuations or changes that would affect eligibility. The demonstration also expands the definition of transportation so eligible program participants can gain access to benefits, including community services and activities based on their service plan.

So far, so good; that's a pretty big deal, especially as we're in the middle of the Medicaid Unwinding process nationally.

However, there's a rather curious provision at the end of the announcement:

Via the Centers for Medicare & Medicaid Services:

CMS marked another important maternal health milestone by approving Medicaid and Children’s Health Insurance Program (CHIP) postpartum coverage expansion in Rhode Island, an opportunity made possible by the American Rescue Plan. With this approval, 32 states and D.C. have extended postpartum Medicaid/CHIP coverage to a full year.

They include links to the approval letters for both Medicaid and CHIP, but the Medicaid one is oddly both extremely brief ("We received your request; it has been approved") and wonky at the same time, while not being in an easy-to-copy text format.

Here's the CHIP letter, however:

Dear Ms. Sousa:

This just in, via CBS News:

The House on Wednesday passed a bill that would raise the debt ceiling and slash trillions of dollars in government spending, delivering House Speaker Kevin McCarthy a victory in his efforts to pressure the White House to begin negotiations ahead of a fast-approaching deadline to avoid a default.

The House voted 217 to 215 to pass the Limit, Save, Grow Act of 2023, with all but four Republican members voting in favor. The Republicans who voted against the bill were Reps. Ken Buck of Colorado, Andy Biggs of Arizona, Tim Burchett of Tennessee and Matt Gaetz of Florida. No Democrats supported its passage.

The measure would lift the debt ceiling by $1.5 trillion or until the end of March 2024, whichever comes first, and cut spending to the tune of $4.5 trillion.

Those cuts mean it's dead on arrival in the Democratic-controlled Senate and President Biden has vowed to veto it.

The Affordable Care Act includes a long list of codified instructions about what's required under the law. However, like any major piece of legislation, many of the specific details are left up to the agency responsible for implementing the law.

While the PPACA is itself a lengthy document, it would have to be several times longer yet in order to cover every conceivable detail involved in operating the ACA exchanges, Medicaid expansion and so forth. The major provisions of the ACA fall under the Department of Health & Human Services (HHS), and within that, the Centers for Medicare & Medicaid (CMS)

Every year, CMS issues a long, wonky document called the Notice of Benefit & Payment Parameters (NBPP) for the Affordable Care Act. This is basically a list of proposed tweaks to some of the specifics of how the ACA is actually implemented for the following year.

Two weeks ago, the Associated Press reported that the Biden Administration planned on opening up eligibility for ACA exchange, Basic Health Program, Medicaid & CHIP coverage to hundreds of thousands of Americans who have Deferred Action of Childhood Arrivals status:

President Joe Biden is set to announce that his administration is expanding eligibility for Medicaid and the Affordable Care Act’s health insurance exchanges to hundreds of thousands of immigrants brought to the U.S. illegally as children, according to two U.S. officials briefed on the matter.

The action will allow participants in the Obama-era Deferred Action for Childhood Arrivals program, or DACA, to access government-funded health insurance programs. The officials spoke on the condition of anonymity to discuss the matter before the formal announcement on Thursday.