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June 22, 2021

Medicaid is officially bigger than ever. What does its future hold?

Daily Briefing

    Medicaid enrollment increased to record highs between February 2020 and January, with around 80 million people now enrolled in the program, according to data from CMS.

    Find out where the states stand on Medicaid expansion

    Medicaid enrollment hits record high

    According to CMS data, Medicaid enrollment increased by 9.7 million from February 2020 to January, a figure that includes the number of people enrolled in the Children's Health Insurance Program (CHIP). Overall, that growth brings overall enrollment in the program to about 80 million people, reflecting a nearly 14% increase over the 12-month period ending Jan. 31, the New York Times reports.

    "This tells us that Medicaid is a critical program for American families," CMS Administrator Chiquita Brooks-LaSure, said. "What we've seen during this pandemic is that people want access to affordable health insurance, and how important it is during a public health crisis."

    "The purpose of Medicaid is for times like this, when there is an economic downturn," Peggah Khorrami, a researcher at the Harvard T.H. Chan School of Public Health, said. "As people are losing jobs, that's where Medicaid comes in and we get people insured that way."

    While enrollment numbers for Medicaid increased sharply, enrollment numbers for CHIP remained relatively flat, CMS' data showed.

    "In past economic downturns, there has been substantial growth in Medicaid enrollment, but it was concentrated among children," Rachel Garfield, co-director of the Kaiser Family Foundation's program on Medicaid and the uninsured. "This time, it's interesting we're seeing much of the enrollment happening among adults."

    But not all states are seeing comparable growth in their Medicaid enrollment. A study published in JAMA found that states that expanded Medicaid under the Affordable Care Act saw enrollment increase faster during the pandemic.

    Why enrollment has increased so much

    In the years before the pandemic, enrollment in Medicaid had been steadily declining, the New York Times reports—in part due to rules passed under the Trump administration that made it more difficult to obtain and maintain Medicaid coverage. 

    But then the pandemic struck, bringing dramatic changes to both the economic and political environment.

    On the economic side, millions of people lost their jobs as lockdowns took effect. Many newly unemployed people lost their existing health insurance, and at the same time they experienced a loss in income that made them eligible for Medicaid.

    Meanwhile, Congress provided states with a 6.2% increase in their Medicaid funding provided the states didn't disenroll patients or implement stricter eligibility requirements. And under new rules adopted during the pandemic, states stopped periodically reviewing the eligibility of Medicaid beneficiaries to determine whether they were still eligible for the program.

    Those eligibility checks will be suspended until the coronavirus public health emergency ends, which the Biden administration has said won't occur until at least the start of 2022.

    According to Matt Salo, executive director of the National Association of Medicaid Directors, members of his group have attributed the jump in Medicaid enrollment to "the gathering up of all the people who otherwise would be cycling or rotating off the program."

    Salo added that, once the public health emergency ends, the situation could change dramatically.

    "If you have a large number of people going from coverage to no coverage … that's a really bad situation for a lot of low-income folks. You definitely don't want to flick a switch and have some huge number … [of] people go off the program," he said. "It's jarring … you want to minimize the mass disruption."

    Brooks-LaSure said she's working to make sure state Medicaid officials will handle eligibility reviews correctly.

    "We are very focused on making sure we don't lose our gains in coverage through unnecessary hoops," she said (Kliff, New York Times, 6/21 [1]; Goldstein, Washington Post, 6/21; Kliff, New York Times, 6/21 [2]).

    Find out where the states stand on Medicaid expansion


    The Daily Briefing editorial team has been tracking where each state stands on Medicaid expansion, combing through lawmakers' statements, press releases and media coverage. In this latest iteration of our Medicaid map, we've determined each state's position and outlined any possible expansion efforts.

    Access the map

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