Medicaid Enrollment Snapshot: December 2013
This report is based on data provided by each of the 50 states and the District of Columbia. Health Management Associates (HMA) asked each state to provide the internal reports they use to track enrollment in the program. Each state’s report included total enrollment and enrollment in certain eligibility categories. Report categories are not standardized across states. Where it was possible to do so, the state enrollment data were grouped to further examine trends in specific Medicaid eligibility categories. The data tables and graphs in this document present “point-in-time” monthly Medicaid enrollment counts for the months of June and December of each year from 2000 through 2013 rather than “ever-enrolled” counts published by CMS. The data were provided to HMA by each state Medicaid program in March and April 2014. Historical data may change over time as states change how they report their enrollment data as well as if a state provides revised data for previous time periods.
Net Change. The data collected for this report are net changes in enrollment across the program and within select eligibility groups, taking into account the net impact of individuals enrolling and disenrolling from the Medicaid program. Because these data are not individual level data and states do not make a distinction between enrollment among current beneficiaries and new beneficiaries, it is not possible to determine from this data the number of individuals that left the program and the number that newly enrolled in a given time period.
Definitions of Medicaid Enrollment. The counts provided by the states reflect all persons with Medicaid eligibility for each month. Every person with Medicaid coverage was counted as an enrollee with the exception of family planning waiver and pharmacy plus waiver enrollees. No adjustment was made for other persons who are enrolled in Medicaid categories with less than full coverage. Therefore the enrollment figures reported here include a small number of individuals that are covered by Medicaid only for emergency services and persons with Medicare and Medicaid dual eligibility enrolled as either Specified Low-Income Medicare Beneficiaries (SLMBs), Qualified Individuals (QIs), and as Qualified Medicare Beneficiaries (QMBs). To the extent possible, state-only health coverage programs and Medicaid expansion CHIP enrollees not funded by Medicaid are excluded.
Non-Disabled Children and Non-Disabled Adults. To remain consistent with other enrollment reports, such as the Medicaid Statistical Information System (MSIS), this report groups disabled children in the elderly and disabled category. However, the detail provided in enrollment reports from states varies in the level of detail available. Most states are able to provide data that breaks out the number of non-disabled children either within the same report or through a separate report. In 2 states (IL and WI) some estimation is required due to differences in report totals to determine the number of non-disabled children. For CA, data available for 2012 onward allows for breakouts of children from adults in each eligibility category reported; this data is used to estimate such breaks in data from 2011 and earlier. Additionally, there are a relatively small number of enrollees whose eligibility pathway was not identified. These individuals were included in the non-elderly non-disabled adult counts unless clearly identified as children.
State Variation in Enrollment Reports. Common variations across the states include how states count “spend-down” enrollees and whether states adjust for “retroactive” eligibiles. Some states include in their enrollment counts persons with excess income that qualify to “spend-down” to Medicaid eligibility whether or not they have incurred sufficient medical costs to become eligible for Medicaid in that month. Other states only include those individuals that have met their “spend-down” requirement. Since a primary goal of this report is to identify trends, these variations have been deemed acceptable given that the state does not change its methodology over time. Data for some states include “retroactive” eligibles, i.e., individuals whose Medicaid eligibility is established at a later date, but whose coverage is retroactive to a prior point in time. Effort was made to use reports that reflect retroactive eligibility where they exist. Yet, it is possible that additional changes occurred after the counts provided for use here.
Differences between this report and preliminary data released by CMS of monthly enrollment trends. Starting in April 2014, CMS began publishing monthly reports that include total Medicaid and CHIP enrollment as part of an initiative to provide data on a broad set of Medicaid and CHIP eligibility and enrollment performance indicators to inform program management and oversight.1 However, this data resource, while providing some of the most timely Medicaid enrollment data in the program’s history, is still in its early stages of development. Notable differences between that data and the data provided here include:
- Definition of Medicaid beneficiary. CMS limits the definition of Medicaid beneficiary to those receiving comprehensive benefits and therefore excludes populations such as 1) partial-benefit Duals (QMBs, SLMBs, QIs), 2) 1115 waivers providing limited benefits, 3) those receiving emergency services through Medicaid due to immigration status issues. The data provided in this report includes all of these groups.
- Inclusion of CHIP. The CMS report combines enrollment figures for Medicaid (Title XIX) and CHIP (Title XXI.) We report these two groups separately; Medicaid enrollment (Title XIX) is included in this report and CHIP enrollment (Title XXI) is included in a separate report https://www.kff.org/medicaid/issue-brief/chip-enrollment-snapshot-december-2013.
- Reporting Method. CMS asks states to submit their enrollment data through an online portal each month, revising data reported for the previous month only. As discussed above, this report is compiled from off the shelf reports states submit to Health Management Associates for June and December of each year. States are asked to submit updated data as far back as they desire each time the data are collected.
- Retroactive Eligibles. Medicaid allows for up to three months of retroactive eligibility. Because of the timeliness of the data collection process, the CMS data do not generally reflect retroactive enrollment. For this report, we ask states to include retroactive enrollment whenever possible.
- Trend. This data sources goes back to 2000, showing enrollment trends in monthly enrollment for December and June between 2000 and 2014. The CMS data captures monthly enrollment before open enrollment for the Marketplaces began (average of enrollment between June and September 2013) and enrollment for January, February and March 2014.
- Enrollment by Eligibility Group. Data reported by CMS shows total enrollment across Medicaid and CHIP, but cannot, at this point in time, show enrollment by eligibility group (children, adults, aged and disabled.) This however, is something that is expected to change in the near future.