2 years ago

A new KFF analysis estimates that enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) will have grown by 23.3 million enrollees, to nearly 95 million, by the end of March. That is when the federal continuous enrollment provision expires, and states can resume disenrollments, which have been paused since February 2020. Millions of beneficiaries are expected to be disenrolled over the next year, and the new estimates illustrate the extent to which enrollment could decline and who will be most affected.

Over half of the 23.3 million enrollment increase is among low-income adults under age 65 (56%), and nearly one-third is among children. According to the KFF estimates, the increase in low-income adults includes 8.9 million (38%) in the Affordable Care Act (ACA) Medicaid expansion group and 5.8 million (25%) other adults (mostly low-income parents) who do not qualify for Medicaid based on disability. Estimated enrollment increases have been smaller for adults eligible based on disability or age (1.3 million) and for CHIP enrollees (0.2 million).

It is expected that the groups that experienced the most growth due to the continuous enrollment provision—ACA expansion adults, other adults, and children—will see the largest enrollment declines.

The increase in enrollment is concentrated in a small number of states with large populations and, consequently, large Medicaid programs. Our analysis shows that California, New York, Texas, Florida, and Illinois account for over one-third of the increase in Medicaid/CHIP enrollment. Because Texas and Florida have not adopted the ACA Medicaid expansion, children and other adults account for higher percentages of enrollment gains in those states.

Growth rates in Medicaid/CHIP enrollment vary considerably by state, ranging from 22 percent in Connecticut to 81 percent in Oklahoma. States that implemented Medicaid expansion after 2020 (Oklahoma, Missouri, Nebraska, Utah, and Idaho) have particularly high enrollment growth.

The number and share of individuals who will be disenrolled across states is expected to vary, but studies estimate that between 5 percent and 17 percent of current enrollees might lose Medicaid coverage. (A previous KFF analysis estimates that between 5.3 million and 14.2 million people will lose Medicaid coverage during the unwinding of the continuous enrollment provision.)

As states start to resume renewal procedures for all current Medicaid enrollees, there is substantial uncertainty as to how much of the Medicaid enrollment growth during the pandemic will be sustained, how many people will transition to other coverage, and how many people could end up uninsured. Our recent analysis of coverage outcomes after disenrolling from Medicaid or CHIP found that nearly two-thirds of people experienced a period of uninsurance. Policies to smooth the transition from Medicaid to other coverage sources could reduce that rate as the Medicaid continuous enrollment period unwinds.

The analysis uses a combination of enrollment data from the Centers for Medicare and Medicaid Services (CMS) Performance Indicator Project (PI data), Medicaid claims data (T-MSIS data), and some state-specific data. (A detailed explanation of the methods is available in the paper.) While our estimates are based on the best available public data on states’ Medicaid and CHIP enrollment, they will likely differ somewhat from data maintained by individual states because we use modeling and assumptions to project enrollment through March 2023 and to allocate states’ adult enrollment across eligibility groups.