Medicaid

I last checked in on the "Georgia Pathways" program (the Peach State's partial-Medicaid expansion program which offiically extends up to 100% of the Federal Poverty Level but which also includes a draconian work reporting requirement) back in January.

At the time, only around 2,500 Georgians had actually enrolled in Georgia Pathways, for a number of rather obvious reasons:

As Leonardo Cuello of the Georgetown University McCourt School of Public Policy noted last winter:

Back in May I noted that North Carolina's ACA Medicaid expansion initiative, which started in December 2023, had officially enrolled more than 450,000 of the estimated 600,000 NC residents eligible for the program.

Cut to a few days ago:

North Carolina Celebrates More Than 500,000 Enrolled in Medicaid Expansion

PRESS RELEASE — More than half a million North Carolinians have now enrolled in Medicaid expansion since the program began seven months ago. Beneficiaries are now able get the quality health care they need at low cost. Governor Roy Cooper was joined by North Carolina Department of Health and Human Services Secretary Kody Kinsley, Dr. Karen L. Smith MD, FAAFP, a family physician in Raeford and Verlina Lomick,CHW-IV, Director of Community Outreach & Advocacy for Kintegra Health and health care advocates to celebrate reaching this major milestone, which had originally been projected to take as long as two years.

via the Centers for Medicare & Medicaid Services (CMS):

• In March 2024, 82,751,338 individuals were enrolled in Medicaid and CHIP, a decrease of 636,453 individuals (0.8%) from February 2024.
  • 75,645,578 individuals were enrolled in Medicaid in March 2024, a decrease of 644,997 individuals (0.8%) from February 2024.
  • 7,105,760 individuals were enrolled in CHIP in March 2024, an increase of 8,544 individuals (0.1%) from February 2024.
• As of March 2024, enrollment in Medicaid and CHIP has decreased by 11,116,668 individuals (11.8%) 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 11,084,981 individuals (12.8%).
  • CHIP enrollment has decreased by 31,687 individuals (0.4%).
• Between February 2020 and March 2023, enrollment in Medicaid and CHIP increased by 23,023,434 individuals (32.5%) to 93,868,006.
  • Medicaid enrollment increased by 22,681,263 individuals (35.4%).
  • CHIP enrollment increased by 342,171 individuals (5.0%).

Before I get started, I want to be clear about two things.

First, what exactly is "Project 2025?"

Via Wikipedia:

Project 2025, also known as the Presidential Transition Project, is a collection of conservative and right-wing policy proposals from the Heritage Foundation to reshape the United States federal government and consolidate executive power should the Republican Party candidate win the 2024 presidential election.

It proposes reclassifying tens of thousands of merit-based federal civil service workers as political appointees in order to replace them with those who will be more willing to enact the wishes of the next Republican president.

It asserts that the president has absolute power over the executive branch.

Critics of Project 2025 have characterized it as an authoritarian, Christian nationalist plan to transform the United States into an autocracy.

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.

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 February 2024, 83,387,167 individuals were enrolled in Medicaid and CHIP, a decrease of 654,280 individuals (0.8%) from January 2024.
  • 76,289,951 individuals were enrolled in Medicaid in February 2024, a decrease of 640,417 individuals (0.8%) from January 2024.
  • 7,097,216 individuals were enrolled in CHIP in February 2024, a decrease of 13,863 individuals (0.2%) from January 2024
• As of February 2024, enrollment in Medicaid and CHIP has decreased by 10,480,839 individuals (11.2%) 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 10,440,608 individuals (12.0%).
  • CHIP enrollment has decreased by 40,231 individuals (0.6%).
• Between February 2020 and March 2023, enrollment in Medicaid and CHIP increased by 22,992,937 individuals (32.4%) to 93,868,006.
  • Medicaid enrollment increased by 22,650,766 individuals (35.3%).
  • CHIP enrollment increased by 342,171 individuals (5.0%).

OK, I'm back from the Doctors for America conference! I'll be posting a write-up about that soon, but in the meantime I have a backlog of healthcare policy developments to catch up on...

Last fall Oregon moved to the next step on their Basic Health Plan program (via Oregon Public Broadcasting):

Oregon becomes 3rd in nation to seek federal approval for a basic health program

A group of volunteer advisors to the Oregon Health Authority has voted Tuesday to make the state the third in the nation to seek federal approval for a basic health program.

...The Oregon Health Policy Board voted unanimously to approve Oregon’s blueprint application. It was the last step in a lengthy policy-making process needed for state approval of the plan after a task force last year recommended moving forward with it.

via the Centers for Medicare & Medicaid Services (CMS):

CMS Approves State Plan Amendments Extending Postpartum Coverage in Nevada

May 3: CMS marked another important maternal health milestone by approving Medicaid and Children’s Health Insurance Program (CHIP) postpartum coverage extensions in Nevada, an opportunity made possible through the American Rescue Plan (ARP). Nationally, people across 46 states, the District of Columbia, and U.S.V.I. now have access to Medicaid and CHIP coverage for a full 12 months following pregnancy — up from just 60 days before the ARP.

Last month I noted that North Carolina's ACA Medicaid expansion initiative, which started in December 2023, had officially enrolled more than 400,000 of the estimated 600,000 NC residents eligible for the program.

I just checked on the official NC Dept. of Health & Human Services Medicaid expansion dashboard, and it says that as of May 3rd, expansion enrollment there was up to 447,498 people.

It will be interesting to see how close to that 600K estimate enrollment ends up being over the next year or so.