Medicaid enrollment has jumped 4.3M since February, could grow much more

Dive Brief:

  • The economic fallout from the COVID-19 pandemic has led to a sizable growth in the nation's Medicaid rolls over the past six months, new analysis by Families USA found. According to the study, which examined Medicaid enrollment trends in 38 states, more than half have seen enrollment grow by 7% or more since February through the early summer. Among those states that have released August enrollment data, growth reached about 11% since February.
  • Kentucky, one of the few Southern states to expand Medicaid eligibility under the Affordable Care Act, reported the biggest jump in enrollment — 17.2% between February and August, with more than 226,000 new enrollees — which the report suggested was partly due to an outreach program to those collecting unemployment benefits. Minnesota was second, with a 14.5% jump in enrollment, or more than 132,000 enrollees. North Carolina, had growth of 12.8%, or nearly 266,000 new enrollees. Among those states with data through July, Medicaid enrollment in Utah grew the most, an increase of 13.7%, or more than 42,000 enrollees.
  • Altogether, Families USA estimates that 4.3 million people have been added to the Medicaid rolls since February. "During the COVID-19 pandemic, Medicaid is working exactly as it was designed to work, ensuring that coverage is available when an economic or healthcare crisis arises," according to the report. However, whether states can pay for the expanded rolls over the long term remains to be seen.

Dive Insight:

Medicaid is one of the biggest safety net programs in the United States, providing health insurance to some 66.8 million Americans, or 20% of the nation's population, as of the end of 2019. And during COVID-19, the Medicaid rolls have grown even further, according to the Families USA analysis.

The report notes that the growth in Medicaid enrollment has been extraordinary. By contrast, it noted that "between February 2019 and August 2019, among all states, Medicaid enrollment averaged a decrease of 0.69%, and no state had more than a 2.1% increase." The exceptions were Virginia and Utah, which had recently enacted an eligibility expansion under the ACA.

Moreover, the report noted that "based on these trends and the continued loss of job-based coverage reflected in weekly new unemployment claims, it is clear that many states are likely to see even more growth in Medicaid enrollment in the coming months."

Some sectors of the economy are rebounding, such as healthcare jobs, which may lessen the growth trends down the line. Moreover, conflicting data from various studies suggest the uninsured crisis may not be as stark as initially believed, but that also remains to be seen.

Congress did initially respond to the economic fallout created by the furloughs and layoffs in response to shutdown and shelter-in-place orders. In March, it passed the Families First Coronavirus Response Act, which created a temporary 6.2% increase in the matching rates the federal government pays to states for funding the Medicaid program. It also temporarily barred disenrollments from the Medicaid program.

However, Families USA observed that "states have made clear that the 6.2% increase is not enough given state revenue shortfalls of 20% or more and Medicaid enrollment increases now exceeding 10% on average."

How this will impact the Medicaid program in the longer term remains to be seen. Citing a study by Health Management Associates, Families USA noted that Medicaid could see an increase in enrollment of up to 18 million by the end of the year — a potential total enrollment increase of 26.9%.