CHIP

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For the past couple of weeks, I've been on a marathon session of analyzing and graphing out total enrollment in Medicaid in every state for each month from 2014 until now (using estimates based on the best available data for the first part of 2021).

Now that I've completed this for all 50 states +DC, I'm bringing it all together into a single national graph showing how enrollment has changed over time.

Aside from the initial ramping up of enrollment after ACA Medicaid expansion went into effect in most states starting in early 2014 (and an odd drop-off/jump in California in the third quarter of 2017), enrollment was pretty steady at the national level...until COVID struck in early 2020.

Since then, the combination of sudden, massive unemployment combined with the Families First & CARES COVID Relief acts (which boost federal funding of Medicaid programs while also prohibiting states from disenrolling current Medicaid enrollees during the public health crisis) have resulted in overall Medicaid enrollment rising dramatically over the past year and a half.

The Kaiser Family Foundation has updated their estimated breakout of the entire uninsured population of the United States as of 2019, and what sort of healthcare coverage they're eligible for thanks to the Affordable Care Act and the American Rescue Plan's expanded/enhanced subsidies.

Obviously a lot has changed since then, primarily due to the COVID-19 pandemic, but I presume this is the most recent comprehensive, reliable data they've been able to compile:

Last week, Joan Alker of the Georgetown University Center for Children and Families noted that a whopping 840,000 children lost Medicaid or CHIP coverage in 2018:

We've taken a closer look at these #'s - check out your state below.
The net national # is 840k kids losing Medicaid/CHIP in 2018 not 860k as we said initially
But in the 39 states losing kids on Medicaid the net total # is worse -- 920,000

https://t.co/dOOD4gyAOw https://t.co/jhs22mNc0w

— Joan Alker (@JoanAlker1) April 26, 2019

There's a link to a whole analysis which breaks the numbers out by state:

We’ve been anxiously awaiting the release of final Medicaid and CHIP enrollment data for 2018, which was expected to be posted almost a month ago. The wait is finally over but not our concerns about what’s happening.

A few years back I posted an entry which breaks out the income eligibility thresholds for Medicaid and CHIP in every state. I've reposted an updated version below, which also takes into account Basic Health Plan (BHP) eligibility in Minnesota and New York. This comes directly from the Centers for Medicare & Medicaid. Note the footnotes at the bottom. The pink cells on the right indicate that the state has not yet expanded Medicaid under the ACA (Maine and Virginia have passed but note implemented doing so, while Medicaid expansion is on the ballot in Idaho, Nebraska and Utah this November).

As a reminder, here's the 2018 Federal Poverty Level income chart for every state except Alaska and Hawaii (Alaska is 25% higher, Hawaii is 15% higher):

This just in...I used to track the monthly Medicaid/CHIP reports pretty religiously, but the total numbers have actually stayed fairly stable month to month for the past year or so (mainly because the states which expanded Medicaid under the ACA have mostly "maxed out" by now). This should start changing in Maine later this year as they voted to expand the program via ballot initiative last November, and Virginia may end up expanding Medicaid to up to 400,000 people there as well later this year.

In the meantime, here's where things stood as of the end of 2017, according to CMS:

Highlights from the December 2017 Report

Medicaid and CHIP Total Enrollment

Welp. In the end, enough Democrats joined Republicans in both the U.S. Senate and House to pass a massive spending bill in the dead of night. Donald Trump signed it into law early this morning.

Needless to say, I'm not happy at all about a major missing piece of the bill: The DREAM act, which would protect around 690,000 young adults who were brought to the United States as children, was not part of the bill. The Dems in the Senate were able to lock in a formal immigration debate which will presumably be focused in large part on DACA and the Dreamers, but there was no such guaranteed baked in on the House side by Speaker Paul Ryan. Personally, I'm pretty disappointed with the 73 Dems who folded on the issue, but the fight isn't over yet.

Still, this site focuses primarily on healthcare policy, and on that front, at least, there's good news: Along with a whole mess of other stuff, here's some of what is included:

That's really about the simplest way I can summarize the situation today:

Daily on Healthcare: Dems agree to deal to reopen government, fund CHIP

by Philip Klein , Robert King and Kimberly Leonard | Jan 22, 2018, 12:52 PM

Dems agree to deal to reopen government, fund CHIP.

The Children's Health Insurance Program (CHIP) has been around for 21 years. It was co-created in a bipartisan way in 1997 by Sen. Ted Kennedy and Sen. Orrin Hatch, with support from Hillary Clinton while she was First Lady of the United States.

CHIP was originally funded as a 10-year program. When the original funding ran out in 2007, it was extended for two years (to 2009) under George W. Bush with little incident (he had previously vetoed an expanded version but later signed the extension of the existing version).

Under President Obama, CHIP was extended (and expanded) again through 2013. The Affordable Care Act added another 2 years to CHIP, extending funding through 2015. In 2015, CHIP funding was extended again, through September 30, 2017.

The completely GOP-controlled Congress allowed CHIP funding to expire. Most state still had a few months worth of money held in reserve for the program, but some started sending out termination notices to the parents of enrollees, letting them know that they'd be kicked off the program within the next month or two.

Last week the Congressional Budget Office reported that funding the CHIP program for 5 years, which they had previously estimated would increase the federal deficit by about $8 billion over the next decade, would instead only increase it by about 1/10th as much: Roughly $800 million, a rounding error when it comes to the federal budget. The reason for this isn't that funding CHIP had suddenly become less expensive, it was instead, ironically, because due to the GOP repealing the ACA's individual mandate starting in 2019, NOT funding CHIP has suddenly become more expensive.

 

Not much to add to this. Here's the state-level breakout of how many children were enrolled in the CHIP program in 2016; it inched slightly upwards this year:

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