Medicaid

Medicaid Unwinding

It's been over six weeks since the last time I checked in on how many Americans had lost Medicaid or CHIP coverage due to the ongoing Medicaid Unwinding process playing out nationally. At the time, "only" 612,000 people had been confirmed to have lost coverage purely due to procedural/red tape reasons (as opposed to others who lost coverage after being determined ineligible any longer).

The Kaiser Family Foundation (KFF) has taken up the mantle on this front, and the data so far, while still limited, is pretty much as bad as many healthcare advocates feared. Since then, a lot more data has been collected and the numbers have grown dramatically:

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

In April 2023, 94,151,768 individuals were enrolled in Medicaid and CHIP.

  • 87,062,629 individuals were enrolled in Medicaid in April 2023, an increase of 348,055 individuals from March 2023.
  • 7,089,139​​​​​​​ individuals were enrolled in CHIP in April 2023, a decrease of 73,121 individuals from March 2023.
  • Since February 2020, enrollment in Medicaid and CHIP has increased by 23,276,699 individuals (32.8%).
    • Medicaid enrollment has increased by 22,982,836 individuals (35.9%).
    • CHIP enrollment has increased by 293,863 individuals (4.3%).

Medicaid enrollment likely increased due to the COVID-19 PHE and Medicaid continuous enrollment condition under the Families First Coronavirus Response Act (FFCRA), which started in March 2020 and ended on March 31, 2023.

Back in March, after years of failed and stalled attempts to get it passed, the North Carolina legislature finally pushed ACA Medicaid expansion over the line to be signed into law by Democratic Governor Roy Cooper.

As for when the program would actually go into effect, however...that's been something of a mystery for awhile now. Apparently the wording of the legislation ties it in with it being included in the general state budget, which hasn't happened yet. As a result, no one seems to be sure whether NC Medicaid expansion will kick off in October, November, December or January of next year.

However, the state's Health & Human Services Dept. has decided to take a proactive, optimistic stance:

State Takes Action To Start Medicaid Expansion Oct. 1; Launch depends on General Assembly acting by Sept. 1

via New York State of Health:

  • Nearly Three Quarters of New Yorkers Enrolled in Medicaid, Child Health Plus or the Essential Plan Have Renewed Their Coverage by the June Deadline; Renewal Strategies Are Working; Others Still Have Time to Act
  • New York Outperforming National Average as Reported by KFF
  • Monthly Dashboard Tracks Renewal Status, Demographics, and State Program Transitions During Public Health Emergency Unwind  

ALBANY, N.Y. (July 18, 2023) – The New York State Department of Health today released the first issue of New York’s Public Health Emergency Unwind Dashboard, a monthly report reflecting data on renewal status, demographics, and program transitions for public health insurance enrollees, which shows renewal outreach strategies are working.  The report indicates that roughly 72 percent of New Yorkers enrolled in Medicaid, Child Health Plus or the Essential Plan renewed their coverage before the June deadline to re-enroll and those who haven’t still have time to act to avoid potential lapses in coverage. As reported by KFF, the national renewal rate for states reporting data is 59 percent.

via MNsure:

ST. PAUL, Minn.—As roughly 1.5 million Minnesotans who currently have Medical Assistance (Minnesota’s Medicaid program) or MinnesotaCare coverage are scheduled to go through the eligibility renewal process over the next year, some will find out they are no longer eligible for these public health care programs and need to find new health insurance. Minnesota’s official health insurance marketplace, MNsure, is here to help those Minnesotans find new coverage.

“If you learn you no longer qualify for Medical Assistance or MinnesotaCare coverage, you may have more health insurance options than you think,” said MNsure CEO Libby Caulum. “MNsure is here to help you and your family understand your options, apply for discounts to save money on monthly premiums, and make a smooth transition to a private health plan if you’re eligible. We can help you find new coverage so you can keep getting the care you need.”

Last month I posted an explainer about a situation in California which boiled down to a huge pot of extra revenue (~$330 million per year, give or take) being fought over between Governor Gavin Newsom and the Democratically-controlled State Legislature.

The bottom line is that this funding was intended to go towards reducing health insurance premiums for ACA exchange enrollees via Covered California as supplemental subsidies to be added on top of federal ACA tax credits...but the passage of the American Rescue Plan and the subsequent Inflation Reduction Act kind of made that moot, since the federal subsidies were made more generous than what the state subsidies would have been anyway.

As a result, Gov. Newsom decided that the extra revenue should go into the general state fund, while Democrats on the state legislature wanted to redirect it to eliminate deductibles and other types of cost sharing for ACA enrollees instead. This led to an impasse for the past several months:

New York

via New York State of Health:

June 30, 2023

Governor Kathy Hochul today encouraged eligible New Yorkers to renew their health insurance coverage as insurance renewal deadlines rapidly approach. The Governor also issued a public service announcement to get the message out to New Yorkers.

Connecticut

via Access Health CT:

These free, in-person events will take place in Bridgeport, East Hartford, Middletown and Torrington

HARTFORD, Conn. (June 27, 2023) — Access Health CT (AHCT) today announced it will host four free, in-person enrollment fairs in July and August to help HUSKY Health enrollees who have been affected by recent legislation. The events will take place in Bridgeport, East Hartford, Middletown and Torrington. HUSKY Health is Connecticut’s Medicaid program.

Medicaid Unwinding is a term the federal government is using to describe the process of resuming reviewing households for Medicaid eligibility after a three-year hiatus during the Public Health Emergency. The eligibility redetermination process resumed April 1.

Connecticut residents that remain eligible for HUSKY Health will likely be automatically reenrolled; those that need to take action will receive mail with instructions.

During this springs Congressional kabuki theater regarding raising the federal debt ceiling, one of the biggest points of contention was House Republicans insistence on tying work requirements (w/stringent reporting) to Medicaid eligibility.

"Work requirements" is as old a saw for Republican politicians as "selling insurance across state lines," and it's just as ineffective and counterproductive (as well as simply being cruel). This debate has been held numerous times before, and the upside of such requirements has been debunked repeatedly, but here he go again:

As Joan McCarter of Daily Kos put it way back in 2015:

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