Musk/Trump Admin finally posts Nov. 2024 Medicaid/CHIP enrollment report: 79.0M, down 0.3% from Oct.

After a concerning 2-month delay, the Centers for Medicare & Medicaid Services (CMS) has finally published an update to the official Medicaid/CHIP enrollment data:

November 2024 Key Findings

Medicaid and CHIP Enrollment

• In November 2024, 79.0 million individuals were enrolled in Medicaid and CHIP.
  • 71.8 million individuals were enrolled in Medicaid, and 7.3 million individuals were enrolled in CHIP.
  • 41.5 million adults were enrolled in Medicaid, and there were 37.5 million Medicaid child and CHIP enrollees.

Medicaid and CHIP Applications Received

• In November 2024, Medicaid, CHIP, Human Services agencies, and State-based Marketplaces received 2.7 million applications, or 0.5 percent more applications, as compared to September 2024.
• The number of applications received has increased by 14 percent since November 2023 and increased by 62 percent since November 2022.

Total Medicaid/CHIP enrollment in November 2024 dropped slightly from October, by 274,000 people.

The all-time high enrollment watermark for Medicaid/CHIP was in April 2023, when it officially hit 94.1 million Americans (95.7 million when you include the U.S. territories).

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 measures Medicaid enrollment a bit differently:

• The MBES report is 7 months out of date (through June 2024) while the Trend Snapshot is only 3 months outdated (through October 2024).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.

The MBES numbers for U.S. territories stood at 1.54 million Medicaid enrollees as of June 2024. If you add those to the Trend Snapshot total for the 50 states +DC, it comes in at 80.9 million as of October 2024.

It's also worth noting that ACA Medicaid Expansion enrollment specifically  was 20.9 million as of June 2024 according to the MBES report. This puts total ACA Medicaid expansion down by around 3 million from the all-time high it reached in May 2023.

Finally, the summary report mentions in passing that ACA exchange enrollment in Qualified Health Plans (QHPs) was ~22.0 million in November, while Basic Health Plan (BHP) enrollment was 1.7 million.

Neither of these is surprising or unexpected, but it's noteworthy that these numbers are being officially recognized by the Musk/Trump admin under the circumstances. It's also worth noting that 22.0 million being enrolled in effectuated exchange coverage in November is higher than the 21.4 million who had selected ACA exchange plans during the 2024 Open Enrollment Period.

As for my concerns about potential manipulation of data by the Musk/Trump Admin, I'm not seeing any obvious red flags in this month's report (the first one released under the new administration).

Total Medicaid/CHIP enrollment is reported as being down, but not by a crazy amount (around 0.3% nationally from October - November). At the state level, six states saw a drop of more than 1.0% (PA: -1.1%; AZ: -1.5%; ME: -1.6%; IN: -2.0%; NM: -2.2%)...while South Dakota saw an enrollment increase of 1.0%.

Again, I'll continue to keep a close eye on this, but it doesn't look like Musk/Trump's CMS are messing with the data as of yet.