Just 3 days ago, I posted a revised 2024 ACA Open Enrollment Period projection, in which I upgraded my prior projection from 18.5 million Americans signing up for either Qualified Health Plans (QHPs) or Basic Health Plans (BHPs) combined nationally to over 19 million doing so. That 18.5M projection was itself a drop from my original projection of 19M QHPs + BHPs combined from a month earlier.
I delved into the various reasons for both my original and revised projections, but the bottom line is that I figured it would end up being somewhere in the neighborhood of 19 - 19.5 million, give or take, likely broken out something like ~18 million QHPs plus another ~1.3 million BHPs in New York & Minnesota only.
I even included 20 million as an outside possibility.
Biden-Harris Administration Releases New Medicaid and CHIP Renewal Data Showing the Role State Policy Choices Play in Keeping Kids Covered
Sec. Becerra Calls on Nine States with the Highest Child Disenrollments to Immediately Take Up Proven Federal Flexibilities to Protect Children and Families; Biden-Harris Administration Extends Federal Flexibilities to States Until End of 2024
Today, the U.S. Department of Health and Human Services (HHS) released new data on state Medicaid and Children’s Health Insurance Program (CHIP) enrollment changes among children and youth since full eligibility renewals for these programs restarted earlier this year. The data released today make it clear that state policy choices have real consequences for children and families during Medicaid and CHIP renewals. States that take up proven flexibilities and strategies from the Centers for Medicare & Medicaid Services (CMS) are better able to protect kids’ coverage – especially when the state has also expanded Medicaid.
Back on November 5th, just a few days into the 2024 Open Enrollment Period, I did some back-of-the-math number crunching and concluded that the odds were pretty good that total 2024 OEP ACA enrollment (including both exchange-based Qualified Health Plans, or QHPs, as well as enrollment in Basic Health Plans (BHPs) in New York & Minnesota only) would break 19 million people for the first time in the ACA's history.
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.
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).
As long-time readers know, every year during the ACA Open Enrollment Period (OEP) I have a tradition of regularly updating a graph tracking how many Americans have enrolled in on-exchange Qualified Health Plan (QHP) policies nationally. The Graph®, as I've come to call it, is how this entire website got started; the logo for ACA Signups even consists of a stylized version of the original version from the 2013 - 2014 OEP.
That first year I attempted to track every conceivable population--on-exchange QHPs, off-exchange QHPs, Medicaid expansion enrollment, SHOP (ACA small business exchange) enrollees) and even the amorphous "sub-26er" populations of young adults enrolled in their parents employer plans thanks to ACA provisions. Some of these were nearly impossible to accurately estimate, but I really tried my best.
Over the next year or two, I not only dropped the categories which I wasn't able to track properly, my tracking of the remaining ones became much more streamlined and sophisticated. Eventually I decided to stick with just two categories: On-exchange QHPs and those enrolled in the Basic Health Plan (BHP) programs in Minnesota and New York.
In June 2023, 92,614,205 individuals were enrolled in Medicaid and CHIP.
85,614,581 individuals were enrolled in Medicaid in June 2023, a decrease of 1,169,095 individuals (1.3%) from May 2023.
6,999,624 individuals were enrolled in CHIP in June 2023, a decrease of 32,449 individuals (0.5%) from May 2023.
As of June 2023, enrollment in Medicaid and CHIP has decreased by 1,304,004 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.
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.
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.
