Medicaid Enrollment Appears to be Accelerating

[Editor’s Note: For updated enrollment numbers, see “Medicaid Enrollment Increases Show Surprisingly Wide Variability Among States“.]

We’ve been keeping a sharp eye on available state data on Medicaid enrollment as the number of Americans filing unemployment claims continues to rise at a historic pace. Medicaid enrollment is closely tied to the economic circumstances of the country. Unfortunately, as we’ve mentioned, federal data from all states won’t be available until July. In the meantime, we have pulled together publicly available state data in as many states as we can (which turns out to be 21 states).

For the states we have been tracking we are comparing their enrollment on a cumulative basis to February – the last month before the pandemic really took hold and widespread shutdowns began. [It is important to note that a provision of the Families First Act prevents states from involuntarily disenrolling anyone enrolled in Medicaid on March 18 so that would also impact enrollment figures as well.]

States post their data at different times, but as May data becomes available, total Medicaid enrollment growth is now 5.8% (15 states) over the past three months and seems to be picking up.

Table showing the impact of COVID-19 on Medicaid enrollment in 15, with a 5.8% percentage change from February to May 2020.

*Montana numbers are Medicaid expansion enrollment only not total program enrollment.

Child enrollment has been tracking overall enrollment closely growing at 5.5% on average (9 states). This is to be expected – when families income drops more kids enroll in Medicaid. Some of these kids may be moving from CHIP to Medicaid.

Table showing the impact of COVID-19 on children's Medicaid enrollment in 9 states, with a 5.5% percentage change from February to May 2020.

Of the states we are able to track, Florida has the largest enrollment increase of just under 10% — with close to half of that enrollment growth occurring in May.  Missouri, Wisconsin and Kentucky are next with enrollment growth in the 8 to 9 percent range. Montana continues to be the only state where there is no real enrollment growth.

Only one of these states (Kentucky) is a Medicaid expansion state, which puts it at an advantage in the following way: New enrollees who are expansion adults only cost the state 10 cents on the dollar whereas everyone else is reimbursed at the state’s regular lower match rate. States currently have their regular match bumped up for non-expansion groups by 6.2%, but in most cases that won’t bring them close to 90% federal share. A state like Florida for example, has a regular match rate of just under 63 cents on the dollar so with the bump it is bringing in 69 cents for all of its enrollees. The state therefore has to pay 31 cents on the dollar for every new enrollee – whereas Kentucky only has to pay 10 cents on the dollar (at least for its new expansion enrollees).

Joan Alker is the Executive Director of the Center for Children and Families and a Research Professor at the Georgetown McCourt School of Public Policy

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