In June, another 62,000 children lost Medicaid or CHIP coverage, bringing the 18-month enrollment decline (between December 2017 and June 2019) to more than 1.1 million children nationwide or an overall 3 percent drop. Based on CMS or state enrollment data, 37 states have experienced declines of enrollment ranging from less than 1 percent to 15.1 percent during this time period.
By now, Say Ahhh! readers know what comes next. Five states — Texas, California, Florida, Illinois, and Missouri – are home to three out of five children who have lost Medicaid and CHIP. But the percentage decline in enrollment is more telling. While Missouri leads the nation with a 15.1 percent decline, enrollment in four other states – Idaho, Louisiana, Utah, and Wyoming – is down by more than 9 percent.
During the same 18-month period, enrollment has grown in 14 states ranging from .01 percent in Oklahoma to 6.9 percent in both Virginia and Alaska. Of note, increases in Virginia are likely the result of the welcome mat effect of Medicaid expansion, which went into effect in January 2019. On the other hand, Alaska has been in recession since 2015 with the nation’s highest unemployment rate illustrating the countercyclical impact of economic downturns on Medicaid enrollment.
Not every state has been consistently moving up or down.
States Regaining Enrollment in 2019 after Experiencing Declines in 2018
- Four states have overcome 2018 enrollment declines and now show an overall enrollment gain in the 18-month period: Connecticut, Nevada, Oklahoma, and Wisconsin.
- Five states with declines in 2018 have seen increased enrollment in 2019 although their cumulative enrollment over the 18-month period still remains in negative territory: Arkansas, Georgia, Oregon, Pennsylvania, and Tennessee.
States Losing Enrollment in 2019 after Experiencing Gains in 2018
- Three states experienced enrollment declines in the first half of 2019 that have wiped out 2018 gains: Kansas, Minnesota, and New York.
- Four states with cumulative growth over the 18-month period have experienced 2019 declines that are eroding earlier gains: Indiana, Nebraska, North Carolina, and South Carolina.
As a reminder, although Medicaid enrollment grows during economic downturns, historically, enrollment does not result in negative growth even in the best of times. As we noted in our longer brief on this issue, only once since the year 2000 has Medicaid enrollment dipped into negative territory. For stakeholders working to address enrollment declines, check out our blog series on regaining enrollment momentum.