Medicaid Expansion

Michigan

I wrote up an analysis of Michigan's preliminary 2022 rate filings for the individual & small group markets back in August.

A week or so ago the Michigan Dept. of Insurance & Financial Services issued their final decisions on approved rate filings.

Not too many changes were made in either market. I get a weighted average increase of 4.6% for individual market plans (MI DIFS puts it at 4.7%), while I get exactly +7.0% for small group plans (MI DIFS puts it at +7.1%).

As I noted in August, the other noteworthy changes are:

Medicaid Expansion map

From about six weeks ago:

KFF estimate that as of today, nearly 2.2 million Americans currently fall into the "Medicaid Gap" in the 12 states which haven't expanded Medicaid under the Affordable Care Act yet...

They also estimate that another 1.8 million uninsured Americans who are eligible for subsidized ACA exchange plans who would be eligible for Medicaid instead if those state actually did expand Medicaid (and perhaps another 100K in Missouri). That's nearly 4.0 million total...

So, how to crack this nut in these holdout states, all of which are either completely or partially controlled by Republicans who have adamantly refused to expand the program no matter what all these years?

Well, there's several options:

Michigan

I'm gonna be posting mea culpas for a few days for missing important ACA-related announcements over the past few weeks.

Michigan's preliminary 2022 rate filings actually came out a solid month ago, but as noted above I'm way behind on my rate filing project this year:

Highlighting Michigan’s increasingly competitive health insurance market, the Michigan Department of Insurance and Financial Services (DIFS) has reported that consumers will have more health plan options from an increased number of insurers on the Health Insurance Marketplace for the upcoming open enrollment period.

“As we look toward the end of the pandemic and beyond, it is critical that Michiganders are able to get the affordable, high quality health coverage they need for themselves and their families,” said DIFS Director Anita Fox. “Consumers will have more options to choose from when shopping for health insurance coverage on the Marketplace during open enrollment later this year.”

CMS Logo

via CMS:

HHS Encourages States to Educate Eligible Immigrants about Medicaid Coverage

Today, the US Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS) issued an informational bulletin to states’ Medicaid and Children’s Health Insurance Program (CHIP) agencies reaffirming that the 2019 Public Charge Final Rule – “Inadmissibility on Public Charge Grounds” – is no longer in effect and states should encourage their eligible immigrant populations to access public benefits related to health and housing. 

Yes on 2 (Missouri Medicaid Expansion)

August 2020:

We did it!

Missouri just voted #YesOn2 to expand Medicaid, and now, because of YOUR vote, over 230,000 hardworking people will have access to life-saving healthcare! pic.twitter.com/azHN0GJjEW

— YesOn2: Healthcare for Missouri (@YesOn2MO) August 5, 2020

March 2021:

Republican lawmakers blocked Medicaid expansion funding from reaching the Missouri House floor on Wednesday, posing a setback for the voter-approved plan to increase eligibility for the state health care program.

Medicaid Expansion map

As I (and others) have written many times, closing the so-called "Medicaid Gap" is one of the trickiest challenges President Biden and Congressional Democrats face when it comes to strengthening and improving the Affordable Care Act.

Once again: Under the ACA, all Americans earning up to 138% of the Federal Poverty Level (FPL)... roughly $17,700/year for a single adult or around $36,500 for a family of four...were supposed to be eligible to join Medicaid regardless of their health status, whether they had kids and so forth.

This was supposed to be the case in all 50 states and the District of Columbia (I'm not sure about Puerto Rico or the other U.S. territories...many ACA provisions never applied to them in the first place).

Unfortunately, one of the major consequences of the NFIB vs. Sebelius Supreme Court Case in 2012 was that expansion of the Medicaid program has to be voluntary on the part of each state.

Medicaid

A few weeks ago, after the Centers for Medicare & Medicaid (CMS) confirmed over 80 million Americans were enrolled in Medicaid or the CHIP program as of January 2021, I posted an analysis which looked at state Medicaid enrollment data beyond January.

While the "thru dates" vary from as early as February to as recent as June, my overall conclusion was that actual total Medicaid/CHIP enrollment as of last month has continued to grow, and now likely stands at more like 88 million. It's even conceivable that it's broken the 90 million threshold as of July.

As I noted:

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.

Oklahoma

Here's the official press release from the Centers for Medicare & Medicaid Services (CMS):

Oklahoma's Medicaid Expansion will Provide Access to Coverage for 190,000 Oklahomans

  • Nearly 120,000 People Will Begin Receiving Full Medicaid Benefits on July 1

The Centers for Medicare & Medicaid Services (CMS) announced today that approximately 190,000 individuals between the ages of 19-64 in Oklahoma are now eligible for health coverage, thanks to Medicaid expansion made possible by the Affordable Care Act (ACA).  On June 1, 2021, the state began accepting applications, and to date, over 120,000 people have applied for and were determined eligible to receive coverage.  On July 1, these individuals will receive full Medicaid benefits, including access to primary and preventive care, emergency, substance abuse, and prescription drug benefits. Thanks to the American Rescue Plan (ARP), Oklahoma is eligible to receive additional federal funding for their Medicaid program, estimated to be nearly $500 million over two years. It is estimated that an additional 70,000 people in Oklahoma who have not yet applied are now eligible for coverage under Medicaid.

Benefits.Gov

I received the following email:

Hi Charles,

Our son's GF moved here (Seattle) last summer from Florida. She was a few months after returning from a teaching gig in Korea (where they met), and unemployed. In FL she wasn't eligible for Medicaid, but a couple weeks after she got here I realized she would in WA.

So she signed up and it's been great, b/c in fact she did need quite a bit of overdue health services.

Now they are moving to Oregon next month and I told her, "so you're going to sign up there, right?". She tells me, "I'm not eligible there".

She shows me the Federal Benefits.gov site, and it lists for Oregon the Florida-like limitations: you have to be a parent or pregnant or disabled, etc.

I go, "that's strange..." and look up the California eligibility. Same story.

I look up WA's own eligibility according to benefits.gov - same story!!! Supposedly she's not eligible for the very same coverage she's actually enjoying right now with full approval.

ACA Signups Logo

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.

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