CHIP

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via the Centers for Medicare & Medicaid Services:

The Biden-Harris Administration is announcing that, beginning today, as many as 720,000 pregnant and postpartum people across the United States could be guaranteed Medicaid and Children’s Health Insurance Program (CHIP) coverage for a full 12 months after pregnancy thanks to the American Rescue Plan (ARP). Medicaid covers 42 percent of all births in the nation, and this new option for states to extend Medicaid and CHIP coverage marks the Biden-Harris Administration’s latest effort to address the nation’s crisis in pregnancy-related deaths and maternal morbidity by opening the door to postpartum care for hundreds of thousands of people.

Medicaid

As I noted last summer and again a few weeks ago, as of this writing the federal Public Health Emergency (PHE) declaration currently set to expire on April 16, 2022):

In March 2020, Congress offered states additional Medicaid funding as long as they agreed to keep everyone enrolled in the program for the duration of the federal public health emergency, regardless of their eligibility status. As of January 2021, nearly 10 million had joined Medicaid or the Children’s Health Insurance Program (CHIP) during the pandemic, pushing enrollment to a record high of more than 80 million people. (Some independent analyses put the current total higher, closer to 90 million.)

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This is potentially a pretty big deal:

As part of the Biden-Harris Administration’s work to advance health equity and reduce health disparities, the Centers for Medicare & Medicaid Services (CMS) is seeking feedback on topics related to health care access, such as enrolling in and maintaining coverage, accessing health care services and supports, and ensuring adequate provider payment rates to encourage provider availability and quality. This Request for Information (RFI) is one of many actions CMS is taking to develop a more comprehensive access strategy in its Medicaid and CHIP programs.

“We are committed to providing equitable access to quality health care and removing any barriers to quality health care,” said Health and Human Services Secretary Xavier Becerra. “We want to hear directly from stakeholders so we can strengthen our programs for the more than 80 million Americans with Medicaid or CHIP health insurance. Together, by advancing health equity, we can ensure quality health care is within reach for everyone who needs it.” 

Medicaid

I wrote about this last summer, but as the Omicron variant wave of COVID-19 seems to be winding down (with an emphasis on seems) and the federal Public Health Emergency (PHE) declaration currently set to expire in 60 days (April 16, 2022), today felt like a good time to repost something about the situation:

What goes up usually goes back down eventually, and that's likely to be the case with Medicaid enrollment as soon as the public health crisis formally ends...whenever that may be.

Well, yesterday Ryan Levi and Dan Gorenstein of of the Tradeoffs healthcare policy podcast posted a new episode which attempts to dig into just when that might be, how many people could be kicked off of the program once that time comes and how to mitigate the fallout (I should note that they actually reference my own estimate in the program notes):

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This is great news, and there's also a small but important wording choice which should be noted:

CMS Commits Over $49 Million to Reduce Uninsured Rate Among Children and Boost Medicaid Enrollment Among Parents, Pregnant People

The Centers for Medicare & Medicaid Services (CMS) committed a record $49.4 million to fund organizations that can connect more eligible children, parents, and pregnant individuals to health care coverage through Medicaid and the Children’s Health Insurance Program (CHIP). Awardees—including state/local governments, tribal organizations, federal health safety net organizations, non-profits, schools, and others—will receive up to $1.5 million each for a three-year period to reduce the number of uninsured children by advancing Medicaid/CHIP enrollment and retention.

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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

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