Analysis of Recent National Trends in Medicaid and CHIP Enrollment
This data note looks at national and state-by-state Medicaid and CHIP preliminary enrollment data through September 2020, as states were still in the early stages of experiencing the health and economic effects of the coronavirus pandemic. After declines in enrollment from 2017 through 2019, preliminary data show that total enrollment grew to 77.3 million in September, an increase of 6.1 million from actual enrollment in February 2020 (8.6%), right before the pandemic and when enrollment began to steadily increase. (Figure 1) Changes are somewhat larger if growth is compared to preliminary data for February 2020. (6.7 million or 9.4%) These early data suggest that recent increases in enrollment are reversing previous trends. These trends likely reflect changes in the economy (as more people experience income and job loss and become eligible and enroll in Medicaid coverage) and provisions in the Families First Coronavirus Response Act (FFCRA) that require states to ensure continuous coverage to current Medicaid enrollees to access a temporary increase in the Medicaid match rate. Because Medicaid enrollment may lag behind increases in unemployment, data for subsequent periods will likely show continued enrollment growth.
The information is based on KFF analysis of the Centers for Medicare and Medicaid Services (CMS) Performance Indicator Project Data. Medicaid/CHIP enrollment data are submitted monthly by state Medicaid agencies and, with each monthly update, states often revise the previous months’ enrollment to include retroactive enrollment and to better align with reporting criteria. Unless otherwise indicated, this report uses the enrollment data from the updated enrollment reports to reflect the most current enrollment data possible.
Medicaid enrollment increased following the implementation of the Affordable Care Act (ACA) but was declining in the two years prior to the pandemic. Following the implementation of the ACA Medicaid expansion to low-income adults in 2014, there were large increases in Medicaid and CHIP enrollment across states that followed steady growth in coverage of children over the past decade. These increases reflected enrollment among newly eligible adults in states that implemented the expansion as well as enrollment among previously eligible adults and children due to enhanced outreach and enrollment efforts and updated enrollment procedures tied to the ACA. This trend began reversing when enrollment started to decline in 2018 and continued to decline in 2019. Total enrollment fell from 73.4 million in December 2017 to 71.1 million in December 2019, a decline of 2.3 million people or 3.1 percent. Month to month enrollment declines slowed but continued until February 2020. The declines in enrollment, in part, reflected a robust economy, but experiences in some states suggested that they may have also reflected enrollment losses among people who were still eligible for coverage due challenges completing enrollment or renewal processes.
Recent data suggest that Medicaid enrollment is increasing amid the coronavirus pandemic. Actual adjusted data from February 2020 to preliminary data in September 2020 show that enrollment increased by 6.1 million or 8.6%. Recent increases could reflect new enrollment related to changes in the economy and job loss, as well as eligibility and enrollment requirements included in the Families First Coronavirus Response Act (FFCRA). Under the FFCRA, to be eligible for enhanced federal Medicaid matching funds, states must ensure continuous coverage for those enrolled as of March 18, 2020 and cannot make eligibility and enrollment more restrictive than policies in place as of January 2020. Over this period, all states experienced enrollment growth ranging from 4% to 18%. (Figure 2)
Enrollment will likely continue to grow as the pandemic continues to negatively impact the economy. Another KFF analysis suggests that job loss and loss of employer sponsored coverage will result in more people eligible for Medicaid, particularly in states that have adopted the Medicaid expansion in the Affordable Care Act (ACA). However, increases in Medicaid enrollment may lag being increases in unemployment. So, as unemployment continues to grow, more people will continue to become eligible and enroll in Medicaid, helping people who lose job-based insurance to maintain coverage but also putting increasing pressure on state budgets. Preliminary national data for the most recent month is lagged for about three months, but future data will provide more clear insight into how national and state-by-state Medicaid enrollment is responding to the pandemic.