CMS releases October 2023 enrollment data: Medicaid/CHIP enrollment dropped another 1.16 million as Medicaid Unwinding continued

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%).

While the continuous coverage provision ended on March 31st, 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 16.2 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 coming months.

On the upside, according to a different report via the HHS Dept, 1.6 million of those who had lost Medicaid/CHIP coverage due to the unwinding process as of the end of  September went on to enroll in either an ACA exchange policy or a Basic Health Plan policy (MN/NY). This represents around 15% of the total "Unwinding" population through October...the first significant spike since last spring (it had been holding steady at around 13% from April - September).

If this rate has held true since then, that would mean at least ~2.4 million members of the Unwinding population have moved to ACA plans...and as it happens, last week CMS reported that 2.4 million federal exchange enrollees were "previously enrolled in Medicaid or CHIP coverage" as of New Year's Eve. This doesn't include the 19 state-based exchanges, 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 88.9 million as of October 2023.

It's also worth noting that ACA Medicaid Expansion enrollment specifically was 24.5 million as of June 2023 according to the MBES report...down just 85,000 from March 2023 (when the continuous coverage provision ended) and just 250,000 from the all-time high it reached in May 2023.