Recently there have been declines in Medicaid and CHIP enrollment, reversing a previous trend of increases following implementation of the ACA. Experiences in some states suggest that renewal process requirements and growing use of periodic eligibility checks may be contributing to disenrollment among people who are still eligible for coverage as well as increased churn in coverage. This brief reviews current rules and state processes related to renewal and periodic eligibility reviews and discusses potential process issues that may be contributing to Medicaid and CHIP enrollment declines.
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Enrollment in Individual Market Dips Slightly in Early 2019 after Repeal of Individual Mandate Penalty
Overall enrollment in the individual market fell 5% to 13.7 million in the first quarter of 2019 following the repeal of the ACA’s individual mandate penalty.
This analysis measures changes in enrollment in the individual market, including those in both marketplace plans and off-exchange plans, before and after the ACA’s coverage expansions and market rules went into effect in 2014 through the first quarter of 2019.
Three key private health insurance markets — Medicare Advantage, the individual market and the fully-insured group market — appear to be financially healthy and attractive to insurers. The private Medicare Advantage market generates significantly larger gross margins per person than the individual market or fully-insured market. The future of these markets has become a focus for policymakers amid the debate over Medicare for All.
This issue brief identifies key lessons learned from how four states (Missouri, Ohio, New Mexico, Rhode Island) are connecting people leaving the criminal justice system to Medicaid coverage and services, with a focus on medication-assisted treatment (MAT) and supports for people with opioid use disorder. It builds on previous briefs that assessed state efforts to connect people involved in the justice system to Medicaid coverage. It is based on interviews conducted in late 2018 and early 2019 with state Medicaid, behavioral health, and corrections officials in the four states and in Bernalillo County, New Mexico, as well as interviews with managed care organizations, providers, and advocates in those states and published information on the states’ experiences.
Less Than One-Third of New Medicare Beneficiaries Enrolled in Medicare Advantage During Their First Year on Medicare
Twenty-nine percent of new beneficiaries chose to enroll in Medicare Advantage during their first year in Medicare in 2016, finds a new KFF analysis. That level generally matches the overall share of beneficiaries who opted for Medicare Advantage that year, but does not support the view that the aging Baby…
The analysis examines enrollment in Medicare Advantage plans during beneficiaries’ first year on Medicare and finds that less than one-third or 29% enrolled in these private health plans, including HMOs or PPOs. The majority of people new to Medicare are choosing traditional Medicare in the year they first go on Medicare. The study looks at how these findings vary across age, Medicaid status, states, and counties.
The analysis finds that people who switched from traditional Medicare to Medicare Advantage in 2016 had health spending in 2015 that was $1,253 less, on average, than the average spending for beneficiaries who remained in traditional Medicare (after adjusting for health risk). The findings suggest that the current payment method may systematically overestimate expected costs of Medicare Advantage enrollees. Adjusting payments to reflect Medicare Advantage enrollees’ prior use of health services could potentially lower total Medicare spending by billions of dollars over a decade.
Medicaid and CHIP Eligibility, Enrollment, and Cost Sharing Policies as of January 2019: Findings from a 50-State Survey
This 17th annual survey of the 50 states and the District of Columbia (DC) provides data on Medicaid and the Children’s Health Insurance Program (CHIP) eligibility, enrollment, renewal, and cost sharing policies as of January 2019.
In November 2018, CMS released new state data on MAGI Medicaid and CHIP application processing time. These data reflect continued progress in reporting of performance indicators that CMS established in 2013 to facilitate data-driven program management and improvement.