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Two Year Trends in Medicaid and CHIP Enrollment Data: Findings from the CMS Performance Indicator Project

Appendix A: Data Overview

At the end of 2013, CMS implemented a new eligibility and enrollment Performance Indicator Project for state Medicaid and CHIP programs, establishing 12 Medicaid and CHIP eligibility and enrollment performance indicators for states to report (listed at the end of the data overview. To date, CMS has reported a limited set of the indicators, including total Medicaid and CHIP enrollment, and enrollment of children in Medicaid and CHIP. Average monthly data for Summer 2013 are provided as a comparison point prior to the ACA major coverage expansions. Child enrollment data are only reported for January 2014 forward. Key definitions of the data are included below:

Pre-ACA Average Monthly Medicaid/CHIP Enrollment: The average number of individuals enrolled in Medicaid and CHIP for each month during the July-September, 2013 period using an average of enrollment numbers submitted by the states for each month in this period. Not all states submitted three months of data; the average is calculated using any months of baseline data that were provided. The unit of measurement is individuals enrolled as of the last day of the reporting period (month).

Post-ACA Medicaid/CHIP Monthly Enrollment: The total unduplicated number of individuals enrolled in Medicaid and CHIP as of the last day of each reporting period, including those with retroactive, conditional, and presumptive eligibility. This indicator is a point-in-time count of total program enrollment, and is not solely a count of those newly enrolled during the reporting period. This number includes only those individuals who are eligible for comprehensive benefits (e.g., emergency Medicaid, family planning-only coverage and limited benefit dual eligible individuals are excluded). Medicaid Section 1115 demonstration populations are included as long as the benefits and networks are comprehensive. CHIP children subject to a waiting period or premium lock-out period are considered eligible but not enrolled and are not included. Data are subject to change based on subsequent CMS enrollment reports. Other reporting on Medicaid and CHIP enrollment by states and researchers may include some beneficiaries excluded in these data (because comprehensive coverage is not provided), or may use a different methodology.

California changed its methodology by removing some limited benefit groups from enrollment beginning in September 2015, which lowered both the pre-ACA monthly enrollment as well as California’s monthly enrollment. However, California data reported for August 2015 and earlier months (as well as the related pre-ACA monthly enrollment) was not updated to reflect this change in methodology.

In this brief, data through January 2016 are used to show change for the two year period since the implementation of the coverage provisions in the ACA. The trends in Medicaid and CHIP enrollment since Summery 2013 reflect a combination of factors including state Medicaid expansion decisions, the Marketplace enrollment periods, and broader factors such as the economic environment. As of June 2016, 32 states, including DC, have adopted the Medicaid expansion for low-income adults. In most of these states, coverage under the expansion went into effect January 1, 2014, although coverage went into effect at later dates in six states – Michigan (April 1, 2014), New Hampshire (August 15, 2014,) Pennsylvania (January 1, 2015), Indiana (February 1, 2015), Alaska (September 1, 2015), and Montana (January 1, 2016). Louisiana has adopted the Medicaid expansion but implementation will begin in July 2016; as a result, the data in this brief do not reflect the Medicaid expansion in Louisiana. Eligibility for parents remains very limited in most states that have not expanded and adults without dependent children are not eligible for coverage in all but one non-expansion state.

While CMS may expand the scope of eligibility and enrollment indicators reported over time, the data will not provide information on the number of newly eligible adults enrolled through the ACA Medicaid expansion. States are reporting enrollment data, including counts of newly eligible adults, as part of the revised CMS federal match claiming forms (MBES data CMS-64 forms). A number of states have not been able to report enrollment data including California through the MBES data.1

Medicaid and CHIP Eligibility and Performance Indicators

Applications, Transfers, and Renewals

1. Total Number of Medicaid and CHIP Applications Received in Previous Week
2. Total Number of Medicaid and CHIP Applications Received in Previous Month
3. Total Number of Medicaid and CHIP Applications Received through Transfers from Marketplace
4. Total Number of Accounts up for Renewal

Determinations

5. Total Number of Individuals Determined Eligible for Medicaid or CHIP
6. Total Number of Individuals Determined Ineligible for Medicaid or CHIP

Efficiency of Application Processing

7. Processing Time for Eligibility Determinations
8 .Total Number of Applications and Redeterminations Pending a Determination

Enrollment

9. Total Enrollment

Call Center Operations

10. Total Call Center Volume
11. Average Caller Wait Time
12. Rate of Abandoned Calls

Key Findings Appendix B: CMS Enrollment Data By State

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