August 2016 CMS Medicaid Report: Net increase of 15.7 million (actually 16.7 million)

Every month I post an entry about the official CMS Medicaid enrollment report, documenting the increase in Medicaid enrollment since ACA expansion went into effect. The numbers were increasing dramatically every month for nearly two years, but started slowing down last fall as most of the expansion states started maxing out on their eligible enrollees.

As of August 2016, total Medicaid enrollment continued to quietly increase for a total of 73.1 million people, with 15.7 million of that being mainly due to the ACA (~11 million via official expansion, ~1 million early additions/transfers and ~4 million "woodworkers").

• Over 73.1 million individuals were enrolled in Medicaid and CHIP in August 2016. This enrollment count is point-in-time (on the last day of the month) and includes all enrollees in the Medicaid and CHIP programs who are receiving a comprehensive benefit package.

(Note: About 8.4 million children were enrolled in CHIP in 2015, so that's around 64.4 million actually enrolled in Medicaid itself)

• 326,887 additional individuals were enrolled in August 2016 as compared to July 2016 in the 51 states* that reported comparable July and August 2016 data.

*(Note: "51 states" is deliberate; it includes DC)

• Looking at the additional enrollment since October 2013 when the initial Marketplace open enrollment period began, among the 49 states reporting both July 2016 enrollment data and data from July-September of 2013, over 15.7 million additional individuals are enrolled in Medicaid and CHIP as of August 2016, a 27.9 percent increase over the average monthly enrollment for July through September of 2013. (Connecticut and Maine are not included in this count because they did not submit enrollment data for the July-September 2013 baseline period.)

• Among states that had implemented the Medicaid expansion and were covering newly eligible adults in August 2016, Medicaid and CHIP enrollment rose by nearly 36 percent compared to the July-September 2013 baseline period, while states that have not, to date, expanded Medicaid reported an increase of over 12.5 percent over the same period.

• These enrollment counts are in addition to the enrollment increases from the nearly 950,000 individuals who gained coverage as a result of the Affordable Care Act before open enrollment began. Seven states implemented an “early option” to expand Medicaid coverage to adults with incomes up to 133 percent of the Federal Poverty Line (FPL) between April 1, 2010 and January 1, 2014, using new state plan authority provided by the Affordable Care Act or a demonstration under section 1115 of the Social Security Act building upon that authority.

As noted in the headline, it's a matter of perspective as to whether these 950,000 people should "count" as being covered "due to" ACA expansion, since most of them were actually transferred over from existing state-funded healthcare programs for low-income residents.

As for the 15.7 million figure, it's important to remember that in addition to those who are enrolled in Medicaid directly due to the ACA expansion provision, there are also several million people who were already eligible for Medicaid even without ACA expansion who have only signed up for the program because of the massive outreach/education program...aka, "woodworkers": Those who either didn't know they were eligible earlier, or didn't know what the enrollment process was, or were previously too embarrassed/ashamed to enroll, etc etc. My best guess as to how many people fall into this category as of August is roughly 3.8 million.

I haven't written about woodworkers since back in May, when Kimberly Leonard of U.S. News & World Report confirmed that a good 2 million Medicaid enrollees counted as "woodworkers"...as of the end of 2014 only. Since then, all evidence suggests that this number has continued to grow steadily, so I feel pretty confident about that 4.2 million figure...and again, 3 months out of date. I presume it's up several hundred thousand more by now.

However, there's still one more category: Those who are newly eligible for traditional (non-expansion) Medicaid. These are people who, like woodworkers, would be eligible for Medicaid even without the ACA...but who only became eligible since October 2013 (that is, via normal life changes to income/employment/etc). I have no idea how many people this includes, but I can't imagine it would be more than 1 million at the outside. This leaves roughly 10.4 million people who are only enrolled in Medicaid specifically due to the ACA's expansion program.

It's worth noting that in addition to the millions of people who would lose their private, individual healthcare policies in the event of a full ACA repeal, around 11.4 million who would be kicked off of Medicaid as well: The 10.4 million eligible due to ACA provisions since the exchanges launched, plus the additional 950K who were enrolled prior to 2014 thanks to other ACA provisions.