What will happen to unprecedented high Medicaid enrollment after the public health emergency?
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Urban Institute research report
- Author(s):
- Buettgens, Matthew, author Green, Andrew, author
- Contributor(s):
- Robert Wood Johnson Foundation, issuing body. Urban Institute, issuing body.
- Publication:
- Washington, DC : Urban Institute, September 2021
- Language(s):
- English
- Format:
- Text
- Subject(s):
- COVID-19 -- economics Medicaid -- economics United States Centers for Medicare & Medicaid Services (U.S.)
- Genre(s):
- Technical Report
- Abstract:
- Medicaid enrollment has risen substantially since the start of the COVID-19 pandemic. Recent data show enrollment jumped by more than 9 million people from February 2020 to January 2021.1 The higher enrollment is driven by two main causes: the unprecedented pandemic-related job losses concentrated in March to June of 2020 and the continuous coverage requirement of the Families First Coronavirus Response Act, which prohibits state Medicaid agencies from disenrolling beneficiaries during the public health emergency (PHE). Even as the economy improves, however, the continuous coverage provision is likely to contribute to even higher Medicaid enrollment through 2021. We analyze state enrollment patterns to determine their main drivers and to project enrollment growth for 2021. We then project two possible disenrollment scenarios for 2022. Our key findings are as follows: (1) We estimate that by the end of 2021, 17 million more nonelderly people will be enrolled in Medicaid than before the pandemic, reaching a total of 76.3 million Medicaid enrollees younger than 65. Our estimate assumes the PHE will expire at the end of 2021. (2) We find that the continuous coverage provision significantly contributes to ongoing Medicaid enrollment growth. In a typical month before the pandemic, many people would lose Medicaid eligibility and fall off the rolls, while other people would gain eligibility and sign up because of changes in income or family composition. Over 21 months, eliminating the disenrollment caused by loss of eligibility translates into a substantial cumulative enrollment increase. (3) A recent change in guidance from the Centers for Medicare & Medicaid Services (CMS) gives states up to 12 months to restore normal income eligibility redeterminations for Medicaid enrollees once the PHE expires, instead of just 6 months under previous rules (CMS 2021). More gradual processing of enrollment over 12 months could reduce unnecessary losses of coverage by allowing more time for planning and outreach. However, the expected loss of the enhanced federal medical assistance percentage (FMAP) in March 2022 gives states a financial incentive to process enrollment more quickly. (4) We estimate that the number of Medicaid enrollees could decline by about 15 million people during 2022. This includes 8.7 million adults and 5.9 million children. We estimate that one-third of adults losing Medicaid coverage after the PHE could qualify for subsidized private health coverage in the Marketplaces. Nearly all of the remainder would likely have access to an offer of employer coverage in their family deemed affordable under the Affordable Care Act (ACA). (5) Many of those losing Medicaid coverage would be eligible for other sources of subsidized coverage. Of the adults who would lose Medicaid, we estimate about a third would be eligible for Marketplace premium tax credits (PTCs) if the enhanced tax credits in the American Rescue Plan Act (ARPA) were made permanent. Of the children losing Medicaid, 57 percent would be eligible for the Children’s Health Insurance Program (CHIP), and an additional 9 percent would be eligible for Marketplace coverage with tax credits. Thus, good coordination between state Marketplaces and Medicaid agencies is essential to reduce unnecessary losses of health coverage.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-DC license. (More information)
- Extent:
- 1 online resource (1 PDF file (iv, 41 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918300288406676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918300288406676