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.

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%).

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 October 2023:

Hmmm...via Covered California:

Covered California announced today that it will give consumers until Feb. 9 to sign up for coverage in 2024.

“We’ve seen record-breaking enrollment nationally, and Covered California is surging with heightened demand,” said Covered California Executive Director Jessica Altman. “We want any Californian who needs health insurance to have the opportunity to get covered for the rest of 2024, and extending the open-enrollment period will ensure they have the time they need.”

In addition to the increased demand, consumers looking to enroll in recent days may have encountered challenges reaching Covered California representatives over the phone, and many this week have experienced longer than expected wait times. This was due in part to a disruption to Covered California’s service center, which was temporarily taken offline in immediate response to a cybersecurity incident affecting a third-party vendor that supports its phone lines.

via Pennie, Pennsylvania's state-based ACA exchange:

• The record number of Pennsylvanians is an increase of over 150,000 – 56 percent – since Pennie launched in 2020.

Harrisburg, PA – Today, Pennie – PA's official health insurance marketplace – announced that a record nearly 435,000 Pennsylvanians are now covered with affordable, high-quality health coverage through Pennie. This represents a 17% increase compared to this time last year, far exceeding the average annual increase of 1%. Marketplace enrollment has increased by over 150,000 in the four years since Pennsylvania took over ownership and operations from the federal marketplace (healthcare.gov) – a 56% increase.