Charles Gaba's blog

For those who just want the capsule version, here it is:

The official ACA Medicaid/CHIP enrollment number that the HHS Dept. has been touting up until now has been 3.9 Million. The number that I've been claiming on the spreadsheet is currently around 4.5 Million. However, based on a very detailed analysis of the first 3 HHS reports, as well as the 2 CMS reports issued last fall, I've concluded that the actual grand total of Medicaid/CHIP enrollments since the ACA exchanges launched on October 1st is actually even higher, possibly as many as 6.4 Million. While they can't officially confirm my numbers and some caveats apply (described below), a CMS official did review my work and concluded that "the methodology appears to be accurate".

Now, before everyone starts freaking out about this claim--and it's an admittedly major one--I want to make two VERY important caveats:

...and, just like that, we're back up above the 10M grand total mark again. Connecticut's private QHP enrollment tally just increased from 40,000 to 44,720, cancelling out the 3,702 that we just "lost" from Nevada a few moments ago. Medicaid/CHIP enrollments also went up by several thousand.

As of Thursday morning, Access Health CT had enrolled a total of 86,000 people, said Kevin Counihan, the marketplace's chief executive. He said about 500 to 1,000 enrollees are being added a day. That means the marketplace, also called an exchange, is on track to meet or exceed its goal of enrolling 100,000 people once the open enrollment period ends on March 31, he said.

Of those 86,000 people, Counihan said 52 percent signed up for private coverage and 48 percent for government-funded Medicaid.

Yesterday I posted an entry on Nevada's enrollment numbers which was a problem because the Nevada Health Link claimed to have lower enrollment figures as of 1/11 than the official HHS report had them at as of 12/28.

I asked them to clarify why HHS had them at 22,566 Private QHP enrollments on 12/28 when they were claiming only 18,864 as of 1/11 (of which only 11,409 were paid).

Today, they responded in a pretty to-the-point fashion:

@charles_gaba Nevada Health Link provides HHS and the public the same stats on a weekly basis. We do not know why the HHS # is incorrect.

— Nevada Health Link (@NVHealthLink) January 16, 2014

Huh.

OK, then...I guess the total just dropped by 3,702, temporarily knocking us back below the 10M total line.

Three updates today, two of which are minor, one is significant; combine all three and we've hit 10 Million altogether (with caveats):

These 3 updates push the Private QHP enrollment tally up to about 2.4 million; add about 4.5 million Medicaid/CHIP enrollments and 3.1 million "sub-26'ers" added to their parents plan thanks to the ACA, and you hit just over 10 million total.

*So, why the asterisk in the title?

Well, it should be noted that:

A few days ago the New York exchange released an oddly-worded press release which mixed some numbers through December 24 with other numbers through January 12. My reading of it at the time was that the state had added roughly 53,000 (private QHP + Medicaid/CHIP combined) since 12/30.

However, today, the Deputy Director of the NY exchange stated that they've been enrolling "about 7,000 per day" total in January...which adds up to 98,000 if you assume that runs through yesterday, the 14th. Even subtracting the extra 2 days, this means her number is 31,000 higher than yesterday's press release, but I'm not about to argue with the Deputy Director of the exchange, so another 98K it is. Assuming this breaks down roughly 72% Private QHP to 28% Medicaid/CHIP (as prior numbers have in NY), that comes to about 70.6K private and 27.4K public.

In addition, this pushes New York over the top in terms of their original CMS projection of 218,000 private QHP enrollments by March 31st. They should easily double that number by the end of the enrollment period, and could potentially hit 2.5x at this rate.

I really, really like the way that the Washington Health Exchange does their press releases. No screwing around, they make the key numbers clear and obvious, and they make sure to separate out unpaid private QHPs as well as Medicaid "redeterminations" (ie, those who already had Medicaid under the pre-ACA rules and are simply renewing it).

As a result, here's where Washington State stands as of January 9: Private enrollments went from 71,205 paid / 72,178 unpaid (143,383 total) to 73,098 / 76,058 (149,156 total), while new Medicaid enrollments increased from 177,065 up to 197,770.

Thus, since Jan. 2nd, WA has increased private QHPs by 4% and Medicaid enrollments by almost 12%.

As an added bonus, WA also separates out the other Big, Important Number: How many Medicaid enrollees are renewals vs. how many are new. I do not include renewals in the spreadsheet in cases where I can separate them out.

Qualified Health Plans: 73,098

Medicaid Newly Eligible Adults: 134,700

Medicaid Previously Eligible but not Enrolled: 63,070

Qualified Health Plan Applicants – Need to Pay   76,058

Some slightly updated numbers out of Oregon today, revealed during a conference call with the director of the beleaguered Cover Oregon exchange. Private enrollments are up from 20K to 23K, and exchange-based Medicaid enrollments up from 39,711 to about 42,000.

In addition, some info on the method of the 115,000 "direct transfers" to Medicaid off of the exchange: Apparently they used food stamp income information to do so, which is pretty clever if you think about it.

More than 65k enrolled so far through exchange, he says, 23k in private plans

— Nick Budnick (@NickBudnick) January 15, 2014

Oregon has enrolled more than 115k in Medicaid via workaround to avoid exchange, using food stamp income info

— Nick Budnick (@NickBudnick) January 15, 2014

Something interesting going on in Nevada. On 12/26, the official Nevada Health Link posted this to their Twitter feed:

Update: As of the 12/23/13 deadline to enroll, 12740 consumers confirmed QHP selections, 6219 have paid. Payment deadline is 12/30/13.

— Nevada Health Link (@NVHealthLink) December 26, 2013

Fair enough; 6,224 paid, 6,521 unpaid through 12/23.

Yesterday I posted a table which shows how all 50 states (+DC) are currently ranking when judged by the original CMS projection numbers. It looks like this:

I've already noted that the State-Level CMS Projection Numbers are, for 40 out of the 50 states (plus DC), not particularly well-arrived at. However, for good or for bad, those are the numbers that the states are "supposed" to be striving for, so let's take a look at how they're doing.

With the official 12/28 HHS numbers in hand plus more recent updates for 13 states, here's where things stand purely on a "% of CMS projection attained" basis.

This is important to understand in cases like Kentucky, which has actually been operating quite successfully but which shows up as performing "poorly" due purely to the absurdly high "projection number" that it was assigned in the first place.

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