Enrollment in Medicaid, CHIP Has Grown 28% During the Pandemic

Enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) has increased by 20.2 million beneficiaries since the start of the COVID-19 pandemic, according to an analysis from the Kaiser Family Foundation (KFF).

The analysis reflects Medicaid and CHIP enrollment data from CMS through October 2022.

Before the pandemic hit in early 2020, Medicaid and CHIP enrollment fluctuated. Enrollment grew significantly after states could expand Medicaid under the Affordable Care Act starting in 2014.

This growth reflected enrollment among newly eligible adults in states that expanded Medicaid. Enrollment also increased among previously eligible adults and children due to enhanced outreach and enrollment efforts around this time.

However, Medicaid enrollment began to decline in 2018 and continued to fall in 2019. Enrollment went from 73.2 million beneficiaries in December 2017 to 70.9 million in December 2019, marking a decrease of 2.3 million people (3.1 percent).

The continuous declines may have reflected the strong economy during 2018 and 2019. However, some states noted that losses could have occurred among beneficiaries who were still eligible for coverage but faced difficulties completing enrollment or renewal processes.

Medicaid and CHIP enrollment increased again between February 2020 and October 2022 by 20.2 million beneficiaries (28.5 percent). Enrollment grew in all states, ranging from 17.4 percent in Alaska to 77.7 percent in Oklahoma.

Oklahoma implemented Medicaid expansion on July 1, 2021, and four other states have expanded Medicaid since 2020: Utah, Idaho, Nebraska, and Missouri. Missouri had the second-highest enrollment increase of 62.7 percent.

Most of the Medicaid and CHIP enrollment growth was attributed to Medicaid. The program gained 20 million beneficiaries between February 2020 and October 2022, indicating a 31.1 percent increase.

Meanwhile, CHIP gained just 232,000 beneficiaries from February 2020, increasing by 3.4 percent. Additionally, 18 states saw declines in CHIP enrollment since the pandemic’s start. This could be due to changes in family income causing children to move from CHIP to Medicaid coverage, KFF researchers noted.

During the pandemic, adult enrollment in Medicaid grew by 39.4 percent or 13.5 million beneficiaries. Child enrollment saw a smaller increase of 17.6 percent or 6.2 million beneficiaries.

Medicaid and CHIP enrollment growth in some states may be attributed to Medicaid expansion, but federal policies related to COVID-19 also helped boost access to coverage.

For example, the Families First Coronavirus Response Act (FFCRA) introduced a continuous enrollment provision, prohibiting states from disenrolling Medicaid beneficiaries during the pandemic in exchange for an increase in the federal Medicaid match rate.

However, Congress has announced that the continuous enrollment provision will end on March 31, 2023, and states can begin disenrollments in April. States will have up to 14 months to process redeterminations and resume regular Medicaid operations.

Between 5.3 million and 14.2 million beneficiaries are expected to lose Medicaid coverage during the unwinding period, KFF projected. Individuals could lose coverage if they no longer qualify for Medicaid or face administrative barriers during the renewal process despite remaining eligible.

“How states manage the large volume of redeterminations during the unwinding of the continuous enrollment provision, as well as how states engage with enrollees and other stakeholders, will impact the continuity of coverage for millions of Medicaid enrollees,” researchers wrote.

According to industry experts, states should prioritize updating enrollee mailing addresses and communicating with beneficiaries about their redetermination plan during the pre-redetermination period. During the determination period, states should monitor performance data and gather feedback from stakeholders.

Partnering with community-based organizations, family-led organizations, and individuals with lived experiences may also help states guide their communities through Medicaid coverage changes and the redetermination process.