In April 2023, states started the method of unwinding the Medicaid steady enrollment provision, a pandemic-era coverage that protected Medicaid protection for thousands and thousands of enrollees. Throughout the unwinding, states redetermined eligibility for everybody on this system and disenrolled those that had been now not eligible or who didn’t full the renewal course of. Earlier than the beginning of the coronavirus pandemic in February 2020, there have been 71 million folks enrolled in Medicaid and CHIP. After the three-year pause in disenrollments, that quantity grew to a document excessive of 94 million folks by April 2023, the month after the tip of steady enrollment. From the outset of the unwinding, there have been main questions associated to how many individuals could be disenrolled versus retain protection and the way that may have an effect on general Medicaid enrollment. Now that almost all states have accomplished the unwinding of the Medicaid steady enrollment provision, it’s potential to take inventory of general renewal outcomes in addition to the place Medicaid enrollment stands and the way present enrollment compares to pre-pandemic ranges, nationally and throughout states. The Medicaid and CHIP enrollment knowledge present more moderen modifications in enrollment that aren’t mirrored in nationwide survey knowledge that report the general uninsured charge in 2023 didn’t change from 2022, though there was a rise within the uninsured charge for youngsters in 2023.
Utilizing knowledge from the KFF Medicaid Enrollment and Unwinding Tracker, this evaluation stories knowledge on unwinding renewal outcomes via June 2024 and examines Medicaid enrollment modifications from February 2020 via Might 2024, the latest federal enrollment knowledge out there, nationally and throughout states. Whereas the out there knowledge present a virtually full image of renewals and disenrollments throughout the unwinding interval, some knowledge are preliminary with instances nonetheless pending in some states. These knowledge mark the tip of KFF’s unbiased effort to make use of state and federal knowledge to watch the Medicaid unwinding. Going ahead, KFF will proceed to trace month-to-month Medicaid enrollment knowledge reported by the Facilities for Medicare and Medicaid Companies (CMS).
Key Takeaways
Throughout the unwinding of the Medicaid steady enrollment provision, over 25 million folks had been disenrolled and over 56 million had their protection renewed. Total, 31% of individuals whose protection was redetermined throughout the unwinding had been disenrolled, however that share ranged extensively throughout states. For instance, 5 states—Montana, Utah, Idaho, Oklahoma, and Texas—have disenrollment charges over 50%, whereas 5 states—North Carolina, Maine, Oregon, California, and Connecticut—have disenrollment charges beneath 20%.
Regardless of thousands and thousands of disenrollments throughout the unwinding, nationally, practically 10 million extra persons are presently enrolled in Medicaid/CHIP than at the beginning of the pandemic. Whereas enrollment amongst adults is over 20% larger than in February 2020, youngster enrollment has practically returned to pre-pandemic ranges and is barely 5% larger.
A number of components doubtless clarify the web progress in Medicaid enrollment. The pandemic could have inspired some individuals who had been beforehand eligible for Medicaid however not enrolled to newly enroll, and throughout the unwinding, many states took steps to enhance their renewal processes to scale back the quantity of people that had been disenrolled regardless of remaining eligible. As well as, a number of states expanded eligibility for sure teams, together with 5 states that adopted Medicaid enlargement because the onset of the pandemic.
Much like the nationwide pattern, Medicaid/CHIP enrollment in most states is larger than it was in February 2020; nonetheless, complete Medicaid/CHIP enrollment has fallen under pre-pandemic enrollment in three states, Montana, Colorado, and Arkansas, and youngster enrollment is decrease in 12 states.
A glance again on each the interval of steady enrollment and the unwinding interval gives quite a few potential classes for Medicaid coverage:
The expansion in Medicaid enrollment throughout the pandemic demonstrated that steady enrollment can stabilize protection by lowering churn in this system that happens when eligible persons are disenrolled after which reenroll inside a brief time period. Starting January 2024, states are required to offer 12 months of steady eligibility for youngsters (beforehand 12-month steady eligibility for youngsters was non-obligatory for states). Many states are increasing on that coverage to offer multi-year steady eligibility for younger youngsters, and in some instances, two-year eligibility for older youngsters and adults although these insurance policies will doubtless enhance state and federal Medicaid spending.
On the identical time, offering steady protection will increase spending and leads to folks being enrolled who usually are not essentially eligible primarily based on their present circumstances. Federal Medicaid spending elevated with rising enrollment throughout the pandemic, however enhanced federal matching funds to states stabilized state Medicaid prices regardless of giant positive aspects in enrollment.
As well as, streamlining renewal insurance policies and procedures, notably growing ex parte or automated renewal charges, can enhance protection retention, however eligibility system capability and performance additionally performs a job.
And, lastly, having well timed and dependable knowledge on renewal outcomes and enrollment permits nearer monitoring of state Medicaid applications to establish issues but additionally to tell the methods and flexibilities that may assist states enhance their processes. In Might, CMS prolonged month-to-month reporting of renewal outcomes knowledge required throughout the unwinding interval to permit for continued monitoring of state applications.
Renewal Outcomes Throughout the Unwinding
On the finish of the unwinding of the Medicaid steady enrollment provision in most states, over 56 million folks had their protection renewed and over 25 million folks have been disenrolled (Determine 1). Though some instances stay pending throughout states, the general disenrollment charge throughout the unwinding was 31%. This charge is considerably larger than KFF and different teams had estimated earlier than the unwinding started and contributed to extra folks being disenrolled throughout the unwinding than had been predicted. Amongst those that had been disenrolled, 69% had been terminated for paperwork or procedural causes. Regardless of efforts by states to scale back the procedural disenrollment charge by conducting extra outreach or pausing disenrollments altogether, the speed remained excessive all through the unwinding. In a extra constructive growth, amongst those that retained protection, over six in ten (61%) had been renewed via ex parte, or automated processes. These automated renewals cut back the paperwork burden on each enrollees and state employees and make it simpler for eligible people to retain protection.
There’s vital variation in renewal final result metrics throughout states (Determine 1). For instance, 5 states—Montana, Utah, Idaho, Oklahoma, and Texas—have disenrollment charges over 50%, with Montana the best at 57%, whereas 5 states—North Carolina, Maine, Oregon, California, and Connecticut—have disenrollment charges beneath 20%. The variations consequence from a wide range of components, together with state renewal insurance policies and procedures, system capability, and the extent to which states adopted flexibilities designed to keep up protection for eligible enrollees. The share of renewals accomplished on an ex parte foundation may play a job. The ex parte renewal charges vary from a excessive of 90% or extra in Arizona, North Carolina, and Rhode Island to a low of 11% or much less in Pennsylvania and Texas.
Nationwide Medicaid Enrollment Tendencies
As of Might 2024, 81 million folks had been enrolled in Medicaid, a rise of about 10 million in comparison with pre-pandemic enrollment (Determine 2). Throughout the pandemic, Medicaid enrollment elevated by 32% or 23 million folks. Because the begin of the unwinding, enrollment has dropped by about 13 million, wiping out over half of the pandemic-era enrollment positive aspects. In consequence, enrollment stays about 13% larger than it was earlier than the beginning of the pandemic.
Grownup enrollment in Medicaid/CHIP stays nicely above pre-pandemic enrollment; nonetheless, enrollment amongst youngsters has practically returned to pre-pandemic ranges. Whereas grownup enrollment remains to be over 20% above enrollment in February 2020, youngster enrollment is barely about 5% larger. Adults skilled a lot larger enrollment progress throughout the pandemic than youngsters. From February 2020 to April 2023, enrollment amongst adults grew by 45% whereas youngster enrollment elevated by a extra modest 20%. With the downturn within the financial system within the early months of the pandemic, extra adults enrolled in Medicaid after which weren’t disenrolled even when their circumstances subsequently modified. Moreover, a number of states adopted Medicaid enlargement, growing eligibility for adults, both simply earlier than or throughout the pandemic, together with Utah and Nebraska in 2020, Missouri and Oklahoma in 2021, and North Carolina and South Dakota in 2023. Though the speed of enrollment decline has been steeper for adults throughout the unwinding interval in comparison with youngsters, enrollment positive aspects for adults stay larger than these for youngsters.
Medicaid Enrollment Tendencies Throughout States
Throughout the unwinding, Medicaid/CHIP enrollment declined in all however two states—North Carolina and Oregon (Determine 4). Whereas enrollment dropped about 14% nationally from March 2023 to Might 2024, throughout states the place enrollment declined, the drop various extensively from 2% in Maine to over 30% in Montana, Utah and Colorado. In most states, the web lower in enrollment was larger for adults than youngsters, however, on the whole, states with the biggest internet decline in enrollment for adults additionally skilled the biggest internet decline in youngster enrollment.
In comparison with pre-pandemic ranges, complete Medicaid/CHIP enrollment stays larger in all however 4 states, and in seven states enrollment is 30% or extra larger (Determine 5). Enrollment has dropped under pre-pandemic ranges by 10% in Colorado, 9% in Montana, 2% in Arkansas, lower than 1% in Tennessee, and stays primarily flat in Iowa. In these states, comparatively average enrollment progress throughout the pandemic was offset by excessive disenrollment charges throughout the unwinding, although it’s unclear what components drove the upper disenrollment charges. In distinction, enrollment is 52% larger in Missouri and 50% larger in North Carolina. Among the many ten states with the biggest internet enhance in enrollment from February 2020 to Might 2024, the rise has been pushed by eligibility expansions throughout the unwinding in 5 of the states—the adoption of Medicaid enlargement in Missouri, Nebraska, North Carolina, and Oklahoma, and a big enhance within the eligibility degree for youngsters in Maine. The remaining 5 states—Hawaii, Indiana, Nevada, Oregon, and Virginia—all skilled giant enrollment will increase throughout the pandemic and retained a lot of the elevated enrollment via the unwinding.
Youngsters’s enrollment is under the pre-pandemic ranges in 12 states as of Might 2024, whereas grownup enrollment is under pre-pandemic ranges in 4 states. Enrollment in Medicaid/CHIP amongst youngsters is down over 14% in Montana, between 6% and 10% in Colorado, Idaho, and Utah, and three% or much less within the remaining eight states. Enrollment is under pre-pandemic ranges for each youngsters and adults in Montana, Colorado, and Arkansas. In Tennessee, grownup enrollment dropped under pre-pandemic enrollment, however youngster enrollment is barely above the sooner degree. Usually, it was anticipated {that a} higher share of youngsters than adults would stay eligible and enrolled. Nonetheless, the drop in youngster enrollment under pre-pandemic ranges in so many states coupled with a rise within the youngster uninsured charge in 2023 means that that some youngsters could have misplaced protection regardless of nonetheless being eligible.
