Charles Gaba's blog

via the Washington Health Benefit Exchange:

Apple Health (Medicaid) renewal letters have begun mailing

The Washington State Health Care Authority (HCA), Washington Health Benefit Exchange (Exchange), and the Department of Social and Health Services (DSHS) have begun mailing letters to Washington Apple Health (Medicaid) clients reminding them to update their contact information and renew coverage to see if they still qualify.

For the first time in over three years, people on Apple Health could lose coverage if their family income has gone up. Federal requirements during the COVID-19 public health emergency (PHE) led to income checks being suspended to keep clients enrolled in Apple Health during the pandemic. However, last December’s federal omnibus spending bill directed states to resume evaluating eligibility of Medicaid enrollees on April 1 to wind down COVID-19 pandemic emergency measures.

Just a quick roundup of a whole series of COVID pandemic "winding down" actions which have taken place or are about to take place:

On March 13th, 2022, the Consolidated Appropriations Act was signed into law, formally setting March 31st, 2023 as the end date for the Medicaid Continuous Coverage provision of the Families First Coronavirus Response Act; since April 1st, so-called "Medicaid Unwinding" has begun.

On January 30th of this year, the Biden Administration announced that the COVID-19 Public Health Emergency would formally end on May 11th, 2023. In light of this, a few days ago, Dan Diamond of the Washington Post reported that federal COVID vaccination mandates will also end less than a week from today:

Most of the time when another state extends postpartum Medicaid coverage from two months to a full year, as allowed for under the American Rescue Plan from two years ago, I simply cross-post the official press release from the Centers for Medicare & Medicaid Services.

This time, however, I have a heads up...it isn't official yet, but it looks like Missouri and Alaska are about to become the 33rd & 34th states to do so. Via David Lieb of the Associated Press:

JEFFERSON CITY, Mo. (AP) — Lower-income new mothers could gain a full year of Medicaid health-care coverage in Missouri under legislation given final approval Friday as part of a national push to improve maternal health.

Back in January, as the 2023 Open Enrollment Period wound down, I posted a colorful graph which tracked ACA Qualified Health Plan (QHP) enrollment over ten years of Open Enrollment Periods.

Today I'm doing the same thing for ACA Medicaid Expansion. The data comes from the Centers for Medicare & Medicaid Services monthly Medicaid Budget & Expenditure System reports.

Unfortunately the MBES reports only run through September 2022; my best guess is that the national total as of March 2023 was up to around 24.4 million or so, roughly 900K higher than what's shown below.

Also keep in mind that if the remaining 10 states had expanded Medicaid under the ACA by now, the grand total would have been up to 3.5 million higher (around 27.9 million nationally).

Aside from various holdout states jumping in as the years have passed, the most notable milestone was the month that the COVID pandemic hit the U.S. in full force, shutting businesses down across the country in March 2020.

No further analysis or comment here; I just think this is a pretty cool graphic...and keep in mind that most of the ~23.5 million people represented here (again, likely over 24M today) would have been utterly screwed without the Affordable Care Act being in place when the pandemic hit. Click the image for a higher-resolution version; the states are listed on the right-hand side, though they might be difficult to make out:

via the Centers for Medicare & Medicaid Services:

• Newly proposed standards and requirements would better ensure access to care, accountability, and transparency for Medicaid or CHIP services, including home and community-based services. 

The Centers for Medicare & Medicaid Services (CMS) today unveiled two notices of proposed rulemaking (NPRMs), Ensuring Access to Medicaid Services (Access NPRM) and Managed Care Access, Finance, and Quality (Managed Care NPRM),that together would further strengthen access to and quality of care across Medicaid and the Children’s Health Insurance Program (CHIP), the nation’s largest health coverage programs. These rules build on Medicaid’s already strong foundation as an essential program for millions of families and individuals, especially children, pregnant people, older adults, and people with disabilities. 

via Nevada Health Link:

First Wave of Nevada Medicaid Redeterminations Happening Now

• Those who lose health coverage through Medicaid can look for plans on NevadaHealthLink.com

(CARSON CITY, Nev.) – As the state unwinds from the federal public health emergency, the Division of Welfare and Supportive Services (DWSS) has begun the reevaluation of all Medicaid enrollments for the first time since 2020 during which you may lose coverage under Medicaid. In April, the first wave of recipients received their renewal packets in the mail. Those who did not respond or who no longer qualify based on income or other factors will lose their benefits starting June 1, 2023. Nevada Health Link is available as the go-to resource to help people stay insured.

Back in January, I noted that total enrollment in healthcare policies either specifically created by or expanded to more people by the Affordable Care Act had broken 40 million Americans:

With last week's report from the Centers for Medicare & Medicaid Services (CMS) touting the record-breaking 16.3 million Qualified Health Plan (QHP) selections during the 2023 Open Enrollment Period (OEP), it's time to take another look at the grand total.

For this, I'm assuming a similar 94% average effectuation rate as of February 1st (2 days from now) to the ASPE report from last year for QHP enrollees. Taken literally, that would mean 15,328,061 effectuated on-exchange ACA enrollees.

Every month for years now, the Centers for Medicare & Medicare Services (CMS) has published a monthly press release with a breakout of total Medicare, Medicaid & CHIP enrollment; the most recent one was posted in late February, and ran through November 2022.

Since December 2022, however, they haven't sent out the normal press release; instead, they included a brief note leading to a Medicaid/CHIP data slideshow , along with another note leading to their new Medicare Monthly Enrollment database.

In any event, according to the spreadsheet I exported, as of January 2023:

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

In January 2023, 93,008,246 individuals were enrolled in Medicaid and CHIP.

• 85,915,795 individuals were enrolled in Medicaid in January 2023, an increase of 629,200 individuals from December 2022.

• 7,092,451 individuals were enrolled in CHIP in January 2023, an increase of 30,891 individuals from December 2022.

• Since February 2020, enrollment in Medicaid and CHIP has increased by 22,358,006 individuals (31.6%).
  • Medicaid enrollment has increased by 22,110,705 individuals (34.7%).
  • CHIP enrollment has increased by 247,301 individuals (3.6%).

The Medicaid enrollment increases are likely driven by COVID-19 and the continuous enrollment condition in the Families First Coronavirus Response Act (FFCRA).

About a year ago, I noted that the state of Oregon had passed a bill which, if the federal waiver is approved by the federal government, would make them the third state in the U.S. to establish a Basic Health Plan program under the Affordable Care Act. As reported by Megan Messerly of Politico at the time:

In Oregon, Democrats passed a bill in March to establish a basic health program, the details of which are being ironed out by a task force that began meeting this week. In Kentucky, Republicans approved $4.5 million in state funds this spring to set up a basic health program, which was signed into law by the state’s Democratic governor. An estimated 85,000 Oregonians and at least 37,000 Kentuckians will be eligible to enroll in the plans as soon as next year.