Medicaid Enrollment Numbers

Get the Facts on Medicaid and CHIP Sign Ups Under the ACA

Medicaid signups during open enrollment exceeded 7 million. The Medicaid enrollment numbers were primarily due to Medicaid expansion, however the increased awareness of Medicaid created a woodworking effect (those who were eligible before the law “came out of the woodwork” to sign up due to awareness of expansion).

Below we will take a look at how the ACA affected Medicaid signups during ObamaCare’s first enrollment period, who signed up for Medicaid and CHIP, how each state faired, and what we can expect moving forward for Medicaid enrollment numbers.

Medicaid Enrollment Number Facts

According to our data over 7 million folks who didn’t have health insurance before the ACA are now covered by Medicaid or CHIP. This is in a large part due to Medicaid expansion, one of the most important aspects of the ACA. Medicaid expansion increased eligibility levels of Medicaid to 138% for everybody, but only in states that choose to expand Medicaid. You can learn more about Medicaid expansion here.

• 7 million Americans enrolled in Medicaid and CHIP with about 1.5 million waiting for their enrollment to go through.

• Almost 1 million more were enrolled earlier in Medicaid Expansion plans in seven states.

• Taking into account those who lost eligibility, enrollments in either Medicaid or CHIP increased by over 6 million October 1st 2013 and April 30th 2014.

• Medicaid and CHIP enrollment is 365 and can be started up to two months retroactively.

• Medicaid expansion primarily expanded eligibility to the working poor, as our most of our nations poorest were already covered under old guidelines.

• The “woodworking effect” meant that Medicaid enrollment numbers include more than just those who qualified under expansion.

New Enrollment in Medicaid and CHIP

by Paul Mullen

While counting Medicaid enrolled numbers is easy, once you have sorted through 51 different state systems, it is hard to estimate how many of these are new, and even harder to estimate how many there would have been without the ACA. The complication is that people are gaining and losing cover all the time, as their employment status or Medicaid eligibility changes. Medicaid, like food stamps, was intended to cover short-term hardships, not to become the long term healthcare system for so many that now depend on it.

An additional complication is that many State Medicaid offices have become overwhelmed by the volume of enrollments, leaving almost 900,000 in California alone waiting to be enrolled. Texas too has had problems with its new Medicaid software, with long waits for enrollment. Those identified by healthcare.gov as eligible for Medicaid were supposed to be passed on to the state for processing but many states have had trouble reading these files, and in the meantime told these people to apply directly to the state. So now we have an unknown number of duplicate enrollments. Nationwide there are probably about 1.5 million people eligible for Medicaid but caught up in state bureaucracy.
While people who qualify through Medicaid expansion should be easy to identify, the enrollment for individual health insurance has also turned up many people who were already eligible for Medicaid or CHIP but who did not know it. In theory, the ACA introduced a “no wrong door” policy, so that an application through the health exchange should be equivalent to an application to the state but in Federal marketplace states this has not worked well, resulting in delays in enrollment, and some double counting of applications.

While Medicaid enrollment is handled by the States, the principal source of enrollment data is CMS which collects it from each state and tries to get it in as consistent a form as possible. Their latest report(1) dated May 1st shows enrollments as at March 31st 2014. Two states Maine and North Dakota did not provide compatible data, also Connecticut and Delaware were missing from the baseline data for September 2013.

First let us look at Medicaid expansion – giving Medicaid coverage to all individuals and families with an income below 138% of federal poverty Level (technically 133% of FPL with 5% of income disregarded). This was intended to apply to all States but the Supreme Court ruled that the federal Government could not force states to comply if they did not wish to, even if the federal government was paying for almost all the cost. As a result only 24 states expanded Medicaid before March 2014. Gallup has reported (2)(based on data for the first quarter of 2014) that the uninsured rate has dropped three times as much in States that expanded Medicaid and ran their own State exchange than it did in States that did not take these actions.

Seven of these states started offering expanded Medicaid before open enrollment began last October and by the end of September had the following enrollments.

Medicaid and CHIP enrollment did not just increase in states that adopted Medicaid expansion. Because the exchange application process for health insurance checked to see if a family might qualify for Medicaid, it identified some 2 million people who were entitled to Medicaid or CHIP but had not claimed it. Avalere(3) report Medicaid enrollment increased by up to 10% in states that did not expand Medicaid!

Between September 30th 2013 and March 31st 2014, Medicaid enrollment in the 46 states +DC that had valid data increased by just over 4.8 million individuals. This will be an underestimate of the total effect for several reasons. First several states had big backlogs in applications to process, estimated at 1.5 million. Second it excludes Connecticut, Delaware, Maine and and North Dakota (mostly small states but in total around 200,000 new Medicaid enrollees). Third it excludes the 949,821 early expansion enrollments.

Unlike open enrollment, which has now come to an end, people can enroll for Medicaid at any time of the year, so we can expect to see these numbers grow. In particular more states have decided to expand Medicaid, after they realized how much it was costing them not to expand it. Michigan started expanded Medicaid on April 1st  and by May 15th had already enrolled 237,329 people, about half its goal of 458,790. New Hampshire starts in July, while other states like Utah and Indiana are reconsidering expansion.  Other states are still enrolling for Medicaid and so when then the CMS April 30th report is published, there are likely to be over 1 million more enrolled since March 31st.

Taking all these together this brings us up to about 7 million new Medicaid recipients, plus a further estimated 1.5 million still waiting to be enrolled.

A detailed look at data for each state by Gaba (4) has estimated a total Medicaid expansion of 8.4 million, apparently including the backlog waiting to be enrolled.

Medicaid Enrollment Number Resources:

We suggest checking official releases from HHS, the CBO, the US census, and popular polls like Gallup for the most current sign-up information (we used all of these sources in our breakdown). Another great resource is acasignsups.net which provides pretty detailed and unbiased looks at sign up numbers as well.