As I keep saying, Medicaid is a first responder to the COVID-19 pandemic with respect to both the health crisis and the ensuing economic crisis. With unemployment rapidly rising to double digits, it was only a matter of time until Medicaid/CHIP started to see enrollment increases. Medicaid enrollment has long been closely aligned with the unemployment rate.
In the past few weeks, two major new studies were released with national and state projections of how Medicaid enrollment is likely to increase. A study by researchers at the Urban Institute for the Robert Wood Johnson Foundation projects that if the unemployment rate reaches 20 percent an estimated 11.8 million to 20.6 million of those losing their employer-sponsored insurance (or about 47%) would enroll in Medicaid. This study also includes instructive estimates for all 50 states and DC based on different unemployment and employer-sponsored insurance sensitivity scenarios. A second study released earlier this week by the Kaiser Family Foundation also looked at those losing their employer-sponsored insurance and made a similar projection that nearly half – or 12.7 million people — would become eligible for Medicaid.
Large as these estimates are, they don’t represent all of the possible increases in Medicaid enrollment. That’s because many low-wage workers didn’t have employer-sponsored insurance to begin with – but their income put them over the eligibility levels for Medicaid – or in non-expansion states, they may not be eligible at all for Medicaid, unless they have a dependent child and very low income. So for these workers who may have lost their jobs or lost hours, their income may now render them newly eligible for Medicaid depending on where they live. (My colleague Tricia Brooks wrote a great blog about how the new $600 bump in emergency unemployment is not counted toward income eligibility.) And the Families First Coronavirus Response Act instituted a freeze on involuntary disenrollment for any beneficiary who was enrolled in Medicaid as of March 18, or anyone who newly enrolls, until after the national emergency declaration has been lifted.
Medicaid is a critical piece of what families need when times are tough, so it is not surprising that the economic collapse is leading to large Medicaid enrollment increases and we are now just starting to see real evidence of that happening.
As Say Ahhh! readers know, CCF has long been tracking Medicaid and CHIP enrollment noting the concerning declines in enrollment in 2018 and 2019 when children’s uninsured rates were beginning to climb. Unfortunately, there is a considerable lag in the reporting of enrollment data by federal CMS. So there is no solid national data that we can look it and probably won’t be until July.
As a consequence, our crack research team at CCF led by Lauren Roygardner began tracking Medicaid data directly from state websites – and we are able to track data in about half of the states.
March data did not yet show any clear signs of an enrollment surge with a pretty even split of modest declines and modest increases.
Data for April is a different story. A dozen states have posted April enrollment data and all but one is showing notable increases in enrollment. So far, states with the largest percentage increases in April compared to February 2020 (when the unemployment rate was still 3.5%) include Missouri (6.5%) Wisconsin (5.1%), Minnesota (4.6%), Maine (4.3%), Kentucky (4.2%) and New Hampshire (3.2%). Moreover, three states have posted May data and increases are even larger: Minnesota (8.4%), Kentucky (8.1%), and North Carolina (3.4%). We have heard anecdotally that some of these are the largest increases a state has ever seen in a month.
With the collapse in state revenues and huge state budget deficits looming and states beginning to experience the expected surge in enrollment, it is clear that the federal government must do more to support state Medicaid expenditures. The HEROES Act that the House will be voting on tomorrow includes a critical additional increase in the federal matching percentage to get to a 14% bump for one year, starting July 1, as my colleague Edwin Park explains here. As the head of the Federal Reserve, Jerome Powell, said yesterday, the federal government must act decisively to prevent the U.S. from slipping into an economic crisis “without modern precedent”.
Without an increase in federal support, states will begin making large cuts to their Medicaid programs (and other areas of the state’s budget) just when families need the most help. This will only multiply the catastrophic health and economic impacts of the COVID-19 crisis that families across the country are facing.
 My colleague Edwin Park blogged about the key findings of the RWJ/Urban study.