What Is Happening With Medicaid Enrollment In Q1 Of 2021?

clipboard with word Medicaid

As regular readers of SayAhhh! know, we have been tracking state administrative data for some early indicators of what is happening with Medicaid enrollment during the pandemic and associated recession.  Federal data that tracks all states is available through November 2020 but at this point in time it lags behind what some states report so we have been tracking state reports.

As of this writing, we have data for 36 states as of March 2021 and Medicaid continues to grow. Overall we find a 17.7 percent total enrollment increase as compared to February 2020.

Unsurprisingly, the two states with the biggest increases are Utah and Nebraska, both of whom implemented Medicaid expansion in 2020. So more interesting is which states comes next: Missouri, Illinois, Indiana, Florida, Kentucky and Minnesota all have total enrollment growth of 24 percent or more.

A smaller number of states report children’s enrollment in Medicaid separately. Here we have data from 25 states showing an average percentage increase of 12.5 percent. Top increases of 15 percent or more for kids are seen in Missouri, Florida, Minnesota, Wisconsin, Colorado, Mississippi, and Oklahoma.

Since Missouri and Florida don’t cover Medicaid expansion adults (yet), the large increases in child enrollment are likely to drive the large increases in total enrollment. And as Tricia Brooks carefully documented at the time, Missouri is one of the states that had enormous losses in children’s Medicaid enrollment from 2017 to 2019, due in part to “red tape” issues.

You can see the spreadsheets here.

An analysis by the Kaiser Family Foundation finds that enrollment increased by 10.8% from February 2020 before the onset of the pandemic to November 2020. As KFF analysts point out, and we concur, enrollment has been growing for a few reasons – economic downturns and rises in unemployment always trigger Medicaid enrollment growth, a handful of states implemented Medicaid expansion for adults in 2020 (Utah, Idaho, and Nebraska), and the Families First Coronavirus Relief Act included a Medicaid (but not a CHIP) disenrollment freeze effective March 2020. Federal data shows a substantial spike in applications in March 2020 (as compared to prior years) for Medicaid and CHIP as substantial job losses began. In this recession, it is possible that income loss rather than job loss is driving more of the increase in Medicaid enrollment.

So, bottom line – Medicaid continues to play a critical role in responding to the extraordinary health and economic challenges that the country has faced during the pandemic by providing affordable, comprehensive health coverage.