Medicaid

Back in January, as the 2023 Open Enrollment Period wound down, I posted a colorful graph which tracked ACA Qualified Health Plan (QHP) enrollment over ten years of Open Enrollment Periods.

Today I'm doing the same thing for ACA Medicaid Expansion. The data comes from the Centers for Medicare & Medicaid Services monthly Medicaid Budget & Expenditure System reports.

Unfortunately the MBES reports only run through September 2022; my best guess is that the national total as of March 2023 was up to around 24.4 million or so, roughly 900K higher than what's shown below.

Also keep in mind that if the remaining 10 states had expanded Medicaid under the ACA by now, the grand total would have been up to 3.5 million higher (around 27.9 million nationally).

Aside from various holdout states jumping in as the years have passed, the most notable milestone was the month that the COVID pandemic hit the U.S. in full force, shutting businesses down across the country in March 2020.

No further analysis or comment here; I just think this is a pretty cool graphic...and keep in mind that most of the ~23.5 million people represented here (again, likely over 24M today) would have been utterly screwed without the Affordable Care Act being in place when the pandemic hit. Click the image for a higher-resolution version; the states are listed on the right-hand side, though they might be difficult to make out:

via the Centers for Medicare & Medicaid Services:

• Newly proposed standards and requirements would better ensure access to care, accountability, and transparency for Medicaid or CHIP services, including home and community-based services. 

The Centers for Medicare & Medicaid Services (CMS) today unveiled two notices of proposed rulemaking (NPRMs), Ensuring Access to Medicaid Services (Access NPRM) and Managed Care Access, Finance, and Quality (Managed Care NPRM),that together would further strengthen access to and quality of care across Medicaid and the Children’s Health Insurance Program (CHIP), the nation’s largest health coverage programs. These rules build on Medicaid’s already strong foundation as an essential program for millions of families and individuals, especially children, pregnant people, older adults, and people with disabilities. 

via Nevada Health Link:

First Wave of Nevada Medicaid Redeterminations Happening Now

• Those who lose health coverage through Medicaid can look for plans on NevadaHealthLink.com

(CARSON CITY, Nev.) – As the state unwinds from the federal public health emergency, the Division of Welfare and Supportive Services (DWSS) has begun the reevaluation of all Medicaid enrollments for the first time since 2020 during which you may lose coverage under Medicaid. In April, the first wave of recipients received their renewal packets in the mail. Those who did not respond or who no longer qualify based on income or other factors will lose their benefits starting June 1, 2023. Nevada Health Link is available as the go-to resource to help people stay insured.

Back in January, I noted that total enrollment in healthcare policies either specifically created by or expanded to more people by the Affordable Care Act had broken 40 million Americans:

With last week's report from the Centers for Medicare & Medicaid Services (CMS) touting the record-breaking 16.3 million Qualified Health Plan (QHP) selections during the 2023 Open Enrollment Period (OEP), it's time to take another look at the grand total.

For this, I'm assuming a similar 94% average effectuation rate as of February 1st (2 days from now) to the ASPE report from last year for QHP enrollees. Taken literally, that would mean 15,328,061 effectuated on-exchange ACA enrollees.

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

In January 2023, 93,008,246 individuals were enrolled in Medicaid and CHIP.

• 85,915,795 individuals were enrolled in Medicaid in January 2023, an increase of 629,200 individuals from December 2022.

• 7,092,451 individuals were enrolled in CHIP in January 2023, an increase of 30,891 individuals from December 2022.

• Since February 2020, enrollment in Medicaid and CHIP has increased by 22,358,006 individuals (31.6%).
  • Medicaid enrollment has increased by 22,110,705 individuals (34.7%).
  • CHIP enrollment has increased by 247,301 individuals (3.6%).

The Medicaid enrollment increases are likely driven by COVID-19 and the continuous enrollment condition in the Families First Coronavirus Response Act (FFCRA).

About a year ago, I noted that the state of Oregon had passed a bill which, if the federal waiver is approved by the federal government, would make them the third state in the U.S. to establish a Basic Health Plan program under the Affordable Care Act. As reported by Megan Messerly of Politico at the time:

In Oregon, Democrats passed a bill in March to establish a basic health program, the details of which are being ironed out by a task force that began meeting this week. In Kentucky, Republicans approved $4.5 million in state funds this spring to set up a basic health program, which was signed into law by the state’s Democratic governor. An estimated 85,000 Oregonians and at least 37,000 Kentuckians will be eligible to enroll in the plans as soon as next year.

via NY State of Health:

• Enrollment Assistors Attend YMCA Kids Day Events Throughout the State to Help Consumers Renew or Enroll in Health Coverage

• Eligibility Redeterminations will be Resuming for Over 9 Million New Yorkers in Medicaid, Child Health Plus and the Essential Plan  

ALBANY, N.Y. (April 27, 2023) – NY State of Health, the state’s official health plan Marketplace, today announced it will participate in the YMCA’s annual Healthy Kids Day, a national initiative featuring free community events with family-friendly activities that promote wellness. Certified enrollment assistors will be available at select YMCAs statewide on April 29, 2023, to provide free help to New Yorkers. They will provide information about upcoming changes to their health insurance, answer questions about renewals, and provide information to uninsured New Yorkers about enrolling in coverage through the Marketplace.  

via the Centers for Medicare & Medicaid Services:

CMS Approves of State of Washington Medicaid Section 1115 Demonstration

April 14: CMS approved an amendment to the State of Washington's Medicaid section 1115(a) demonstration, titled “Medicaid Transformation Project." Approval of this demonstration amendment includes several improvements, like historic continuous eligibility for Medicaid children from the point they become eligible until they reach age six, regardless of income fluctuations or changes that would affect eligibility. The demonstration also expands the definition of transportation so eligible program participants can gain access to benefits, including community services and activities based on their service plan.

So far, so good; that's a pretty big deal, especially as we're in the middle of the Medicaid Unwinding process nationally.

However, there's a rather curious provision at the end of the announcement:

Via the Centers for Medicare & Medicaid Services:

CMS marked another important maternal health milestone by approving Medicaid and Children’s Health Insurance Program (CHIP) postpartum coverage expansion in Rhode Island, an opportunity made possible by the American Rescue Plan. With this approval, 32 states and D.C. have extended postpartum Medicaid/CHIP coverage to a full year.

They include links to the approval letters for both Medicaid and CHIP, but the Medicaid one is oddly both extremely brief ("We received your request; it has been approved") and wonky at the same time, while not being in an easy-to-copy text format.

Here's the CHIP letter, however:

Dear Ms. Sousa:

This just in, via CBS News:

The House on Wednesday passed a bill that would raise the debt ceiling and slash trillions of dollars in government spending, delivering House Speaker Kevin McCarthy a victory in his efforts to pressure the White House to begin negotiations ahead of a fast-approaching deadline to avoid a default.

The House voted 217 to 215 to pass the Limit, Save, Grow Act of 2023, with all but four Republican members voting in favor. The Republicans who voted against the bill were Reps. Ken Buck of Colorado, Andy Biggs of Arizona, Tim Burchett of Tennessee and Matt Gaetz of Florida. No Democrats supported its passage.

The measure would lift the debt ceiling by $1.5 trillion or until the end of March 2024, whichever comes first, and cut spending to the tune of $4.5 trillion.

Those cuts mean it's dead on arrival in the Democratic-controlled Senate and President Biden has vowed to veto it.