Medicaid and exchange enrollment update

This week, our In Focus section reviews updated information issued by the Department of Health & Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) on Medicaid expansion enrollment from the “March 2020 Medicaid and CHIP Applications, Eligibility Determination, and Enrollment Report,” published on June 22, 2020. Additionally, we review 2020 Exchange enrollment data from the “Health Insurance Exchanges 2020 Open Enrollment Period: Final State-Level Public Use File,” published by CMS on April 2, 2020. Combined, these reports present a picture of Medicaid and Exchange enrollment in early 2020, leading up to the COVID-19 pandemic and representing 70.9 million Medicaid and CHIP enrollees and 11.4 million Exchange enrollees. Medicaid/CHIP and Exchange enrollment is expected to rise in 2020 according to a team of HMA Medicaid experts, health economists, and data analysts. Read the previous In Focus on HMA’s forecast model.

Key Takeaways from Medicaid Enrollment Report

Across all 50 states and DC, Medicaid and CHIP enrolled nearly 70.9 million individuals as of March 2020.
Medicaid and CHIP enrollment is down more than 1.7 million members since March 2019, a 2.4 percent decrease in enrollment.
Since March 2019, 17 states saw positive percentage growth in Medicaid and CHIP. Only Idaho saw double digit growth (20.3 percent) after it expanded Medicaid in January 2020. The highest growth among the remaining states was seen in Utah (9.8 percent), which also expanded in January 2020; Alaska (3.5 percent); Indiana (3.2 percent); Alabama (2.8 percent); and Arizona (2.6 percent). Nebraska and Oklahoma have passed ballot measures but have yet to implement expansion. Nebraska is expected to implement expansion in October 2020.
Over that same period, 33 states and DC saw a net decline in Medicaid and CHIP enrollment.
As of March 2020, national Medicaid and CHIP enrollment is up 13.2 million (22.9 percent) from the “Pre-Open Enrollment” period, defined as July 2013 through September 2013.
The top five states in percentage growth of Medicaid and CHIP enrollment since the Pre-Open Enrollment period are Kentucky (97.5 percent), Nevada (88.6 percent), Alaska (83 percent), Montana (65.8 percent) and New Mexico (62.9 percent). All five are Medicaid expansion states.
The top five states in percentage growth of Medicaid and CHIP among states that did not expand Medicaid are Georgia (16.7 percent), Alabama (16.1 percent), Tennessee (14.7 percent), South Carolina (13.7 percent), and North Carolina (11 percent).
The top five states in total enrollment growth of Medicaid and CHIP are California (3.7 million), Washington (602,346), Kentucky (591,556), Pennsylvania (547,919), and Arizona (544,974).

Table 1 – Overall U.S. Medicaid/CHIP Enrollment Growth – Pre-Open Enrollment Monthly Average through March 2020

Key Takeaways from 2020 Exchange Enrollment Report

Final Exchange enrollments for the 2020 plan year, published in April 2020, showed that Qualified Health Plan (QHP) plans have been selected by 11.4 million individuals across all 50 states and DC.
2020 QHP selections are down approximately 35,000 from 2019 QHP selections, a decline of 0.3 percent across all 50 states and DC.
Only two states saw double-digit percentage growth in QHP selections – Mississippi (11.7 percent), a State-Based Marketplace, and Iowa (10.9 percent), a State Partnership Exchange. Fifteen states saw increases between 0 percent to 10 percent.
A total of 22 states saw declines in QHP selections between 0 percent and 5 percent. Another eight states saw declines of 5 percent to 10 percent. A total of four states saw double-digit percentage declines in QHP selections from 2018 to 2019.
Overall, Federally-Based administration models saw a decline in enrollment, while State-Based Marketplaces saw an increase of 3 percent.

Table 2 – Overall U.S. Exchange QHP Selection Growth – 2019 through 2020