CMS releases March 2024 enrollment data: Medicaid/CHIP enrollment dropped another 636K as Medicaid Unwinding started tapering off

via the Centers for Medicare & Medicaid Services (CMS):

• In March 2024, 82,751,338 individuals were enrolled in Medicaid and CHIP, a decrease of 636,453 individuals (0.8%) from February 2024.
  • 75,645,578 individuals were enrolled in Medicaid in March 2024, a decrease of 644,997 individuals (0.8%) from February 2024.
  • 7,105,760 individuals were enrolled in CHIP in March 2024, an increase of 8,544 individuals (0.1%) from February 2024.
• As of March 2024, enrollment in Medicaid and CHIP has decreased by 11,116,668 individuals (11.8%) since March 2023, the final month of the Medicaid continuous enrollment condition under the Families First Coronavirus Response Act (FFCRA) and amended by the Consolidated Appropriations Act, 2023.
  • Medicaid enrollment has decreased by 11,084,981 individuals (12.8%).
  • CHIP enrollment has decreased by 31,687 individuals (0.4%).
• Between February 2020 and March 2023, enrollment in Medicaid and CHIP increased by 23,023,434 individuals (32.5%) to 93,868,006.
  • Medicaid enrollment increased by 22,681,263 individuals (35.4%).
  • CHIP enrollment increased by 342,171 individuals (5.0%).

While the continuous coverage provision ended on March 31st, 2023 (fourteen months ago), enrollment in Medicaid actually continued to increase for one month more in April, to an all-time high of 94.1 million Americans.

According to KFF's Medicaid Unwinding tracker, as of late June 2024, at least 23.8 million people have lost Medicaid/CHIP coverage since April 2023; those numbers will continue to be reflected in the official CMS Medicaid enrollment reports over the next few months.

On the upside, according to a different report via the HHS Dept, 4.8 million of those who had lost Medicaid/CHIP coverage due to the unwinding process as of the end of March went on to enroll in either an ACA exchange policy or a Basic Health Plan policy (MN/NY). This represents 25% of the total "Unwinding" population through the end of March 2024.

Another 3.3% or so (at least 595,000) were found likely eligible for Medicaid/CHIP after all; presumably the vast bulk of them have since re-enrolled in those programs.

The fate of the remaining 72% or so is unknown, however.

One important caveat: As always, it's important to note that CMS actually has two different reports on Medicaid enrollment: The monthly Medicaid & CHIP Enrollment Trend Snapshot (referenced above) and the Medicaid Budget & Expenditure System (MBES).

Each type of report includes some data that the other doesn't, but each also measures Medicaid enrollment a bit differently:

• The MBES report is 8 months out of date (through September 2023) while the Trend Snapshot is only 3 months outdated (through February 2024).

• The MBES count includes individuals enrolled in limited benefit plans and the Performance Indicator count does not include such individuals.

• The MBES data represents the count of unduplicated individuals enrolled in the state’s Medicaid program at any time during each month in the quarterly reporting period, while the Performance Indicator data captures the count of individuals enrolled on the last day of the month.

• The MBES count only includes individuals whose coverage is funded through Medicaid (title XIX of the Social Security Act), while the published Performance Indicator also includes individuals funded through CHIP (title XXI of the SSA).

• MBES and Performance Indicator data may be derived from different state systems.

• Retroactive state adjustments to MBES or Performance Indicator data may be in progress.

• States have likely generated MBES data and Performance Indicator data from state systems on different dates.

• The other major difference: The MBES reports include Medicaid enrollees in the U.S. territories: American Samoa, Guam, N. Mariana Islands, Puerto Rico and the U.S. Virgin Islands.

Some of these actually cancel each other out: Some are higher in the Trend Snapshot reports while others are higher in the MBES counts. In fact, the MBES report put the grand total of Medicaid/CHIP enrollees nationally at 94.37 million as of September 2023, but again, the different definitions make this a bit fuzzy.

The MBES numbers for U.S. territories stood at 1.65 million Medicaid enrollees as of September 2023. If you add those to the Trend Snapshot total for the 50 states +DC, it comes in at 85.0 million as of February 2024.

It's also worth noting that ACA Medicaid Expansion enrollment specifically  was 23.2 million as of September 2023 according to the MBES report. This puts total ACA Medicaid expansion down by around 1.5 million from the all-time high it reached in May 2023.