Medicaid

The Centers for Medicare & Medicaid Services (CMS) has been a bit odd when it comes to announcing new states joining the 12-month postpartum Medicaid coverage approval. Sometimes they issue a fully-detailed press release, as they did with Missouri a month ago; other times, like today, they just sort of throw a quick mention into a larger "roundup" post:

CMS Approves Postpartum Coverage Extensions for Nebraska & Mississippi

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

• In August 2023, 89,994,594 individuals were enrolled in Medicaid and CHIP.
  • 83,029,628 individuals were enrolled in Medicaid in August 2023, a decrease of 1,488,269 individuals (1.8%) from July 2023.
  • 6,964,966 individuals were enrolled in CHIP in August 2023, a decrease of 30,312 individuals (0.4%) from July 2023.
• As of August 2023, enrollment in Medicaid and CHIP has decreased by 3,862,970 individuals 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 3,699,342 individuals (4.3%).
  • CHIP enrollment has decreased by 163,628 individuals (2.3%).
• Between February 2020 and March 2023, enrollment in Medicaid and CHIP increased by 22,982,495 individuals (32.4%) to 93,857,564.
  • Medicaid enrollment increased by 22,649,177 individuals (35.3%).
  • CHIP enrollment increased by 333,318 individuals (4.9%)

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.

Today, it became a reality:

Nearly 600,000 North Carolinians Now Have Access to Medicaid Expansion Coverage

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.

A couple of weeks ago, Ariel Hart of the Atlanta Journal-Constitution reported that after over a decade of refusing to consider ACA Medicaid expansion for over 400,000 state residents, Georgia's Republican-controlled legislature may finally be warming up to the idea of embracing full expansion of the program:

For the first time in a decade, high-ranking Georgia GOP legislators on Thursday convened a meeting to hear testimony on full Medicaid expansion to all the state’s poor people.

At the hearing Thursday, the idea was floated over whether to expand Medicaid in exchange for a political deal to roll back regulations that restrict who can open a new health care business. Those regulations are called Certificate of Need, or CON.

For ten years, Georgia has remained one of the states which, frustratingly, has refused to expand Medicaid to all adults earning up to 138% of the Federal Poverty Level (FPL)...a bit over $20,000/year for a single adult; roughly $41,000/yr for a family of four.

If the state were to join most of the country, an estimated 434,000 Peach State residents would finally be able to enroll in comprehensive, nominal-cost healthcare coverage: Around 252,000 who earn less than 100% of FPL and another ~182,000 who earn between 100 - 138% FPL (the second batch 

After years of pressure, a few years back GOP Governor Brian Kemp kind of, sort of agreed to a partial expansion of Medicaid...with a pretty big caveat:

Earlier this week the Centers for Medicare & Medicaid Services (CMS) announced that they had approved Missouri's plan to take advantage of the Biden administration's Maternal Health Blueprint (made possible by the American Rescue Plan & Consolidated Appropriations Act) to extend postpartum Medicaid/CHIP coverage to a full 12 month period:

As a result of today’s announcement, up to an additional 18,000 people in Missouri will be eligible for Medicaid for a full year after pregnancy. Medicaid covers 41% of all births in the nation and more than half of all children in the country. With the approval of Missouri’s plan, an estimated 641,000 Americans across 40 states, the District of Columbia, and the U.S. Virgin Islands now have access to extended postpartum coverage. If all states adopted this option, as many as 720,000 people across the United States would be guaranteed Medicaid and CHIP coverage for 12 months after pregnancy.

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

Thanks to the Biden-Harris Administration’s efforts to strengthen maternal health, an estimated 641,000 Americans annually are now eligible for essential care for a full year after pregnancy.

Originally posted 10/31/23; updated 11/08/23

Back in September, Amy Lotven of Inside Health Policy found an excellent scoop from a new CMS report hiding in plain sight:

New CMS data, quietly released in late August, show about 178,000 consumers chose a qualified health plan (QHP) through a state or federal exchanges after losing Medicaid and CHIP coverage in the first two months of the Medicaid unwinding. Those sign-ups through the end of May are more than three times the 54,000 enrollments that CMS reported in July, which reflected only the April numbers.

Last week I reported that at least 593,000 of the "Medicaid Unwinding" population (Americans who had their Medicaid or CHIP coverage terminated since the end of the COVID public health emergency's "Continuous Coverage" provision ended at the end of March) had shifted over to an ACA exchange plan as of the end of July (plus another 88K who enrolled in BHP plans).

As I noted at the time, perhaps 11% or so of the Unwinding population might move to ACA exchange policies instead when the dust settles on the ongoing unwinding process (12% or so if you include BHP enrollees).

Today, Amy Lotven of Inside Health Policy reports some additional data which indirectly supports this: