States with Highest COVID Medicaid Enrollment May See Big Losses Post-PHE

With Medicaid continuous enrollment coming to an end on March 31, 2023, states are expected to see a decline in Medicaid enrollment after three years of growth, a Kaiser Family Foundation (KFF) analysis indicated.

“It is expected that the groups that experienced the most growth due to the continuous enrollment provision—ACA expansion adults, other adults, and children—will see the largest enrollment declines,” the press release explained.

Given this expectation, the researchers analyzed which states saw the highest Medicaid enrollment growth to predict which could see the greatest losses. Data for this analysis came from the CMS Performance Indicator Project, state-specific data, and Medicaid claims. The researchers noted that their models and assumptions could create slight differences in the data.

The states with the highest Medicaid enrollment growth tended to be states with large populations. California, Florida, Illinois, New York, and Texas had the largest gains, contributing more than a third of Medicaid enrollment during the study’s timeframe. More than 2.8 million Californians joined the state’s Medicaid program between February 2020 and March 2023.

However, Oklahoma had the highest percent growth compared to its February 2020 Medicaid enrollment. The state’s 582,500 enrollees represented an 81 percent increase over its enrollment pre-pandemic. This is in part attributable to the state’s decision to adopt Medicaid expansion during the coronavirus pandemic.

Medicaid expansion was not the sole driver of large Medicaid enrollment gains during the pandemic.

If states experienced volatile enrollment trends pre-pandemic with high churn rates, the stability of continuous enrollment would allow them to see steady growth. Also, some states implemented more comprehensive outreach programs. And the pandemic impacted states’ economies differently, which can affect Medicaid enrollment.

The analysis showed that 63 percent of Medicaid enrollees during the coronavirus pandemic were low-income adults ages 65 and under, nearly 40 percent of whom were in a Medicaid expansion group. Children accounted for another third of enrollment.

Over 23.3 million individuals enrolled in Medicaid between February 2020 and March 2023. The experts predicted that total Medicaid enrollment would hit 95 million enrollees in March 2023. A quarter of enrollment at the end of March 2023 will be Medicaid beneficiaries who enrolled during the pandemic.

After continuous enrollment ends, experts have provided a broad range of estimates for the resulting coverage loss. Some studies say that 5 percent of enrollees will lose coverage, while others anticipate a 17 percent decrease in enrollment. The Department of Health and Human Services (HHS) projected 15 million people would be disenrolled from Medicaid.

Low-income parents and new mothers will face the highest risk of disenrollment, the KFF researchers expected.

“Actual enrollment outcomes will vary across states depending on an array of state policy decisions including how states prioritize renewals and efforts to conduct outreach and enrollment assistance,” the KFF analysis concluded.

“These policies can help ensure that those who remain eligible for Medicaid are able to retain coverage, and that those who are no longer eligible can transition to other sources of coverage, particularly the ACA marketplace.”