Medicaid and CHIP Enrollment Surges Amid Pandemic, Native People at Risk as Federal Continuous Enrollment Provision Expires

Preliminary data for December 2022 shows that total Medicaid and CHIP enrollment grew by 21.2 million to a total of 92.3 million since February 2020. KFF estimates that Medicaid/CHIP enrollment will reach 95 million by March 2023.  This increase in enrollment is due, in part, to the continuous enrollment provision created by the Families First Coronavirus Response Act (FFCRA), which generally barred states from disenrolling Medicaid enrollees in exchange for receiving a temporary increase in the federal match rate. The federal continuous enrollment provision expired on March 31, 2023, meaning that states can now resume disenrollments, which had been paused since Congress passed FFCRA in March 2020. The Affordable Care Act (ACA) Medicaid expansion adults, other adults, and children experienced the most growth due to the continuous enrollment provision and are expected to see the largest enrollment declines after disenrollments resume.  Studies estimate that between 5% and 17% of current enrollees may lose their Medicaid coverage.

Increase in enrollment is concentrated in a small number of states with large populations, and therefore large Medicaid programs. One-third of the increase is found in California, New York, Texas, Florida, and Illinois. States who have implemented Medicaid expansion after 2020 – Oklahoma, Missouri, Nebraska, Utah, and Idaho – also have high enrollment growth. According to KFF “[h]ow states manage the large numbers 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.”

Estimated Enrollment Growth From February 2020 to March 2023, by Eligibility Group and State

Medicaid Unwinding and American Indians and Alaska Natives (AI/ANs)

Native people may be at an increased risk of disenrollment in Medicaid and CHIP programs during the Medicaid unwinding period. Once disenrollments are completed, estimates say 12% of AI/AN children and 6% of AI/AN adults will lose CHIP or Medicaid coverage. There are also administrative barriers that may lead to a higher risk of losing coverage, such as geographical remoteness, limited access to internet or phone service, and language barriers.

Patients at Urban Indian Organizations (UIOs) may lose their Medicaid coverage as a result of the unwinding, and inadequate health insurance coverage or gaps in coverage may cause UIO patients to delay or avoid medical care altogether.  The federal government has a trust responsibility to provide federal health services to maintain and improve the health of AI/AN people. Medicaid and CHIP are critical to fulfilling the United States’ trust responsibility to maintain and improve AI/AN health.  NCUIH recently led over 200 organizations in urging the Administration to take concrete steps to ensure that eligible individuals and families do not lose Medicaid/CHIP coverage for purely administrative reasons during the unwinding period. You can read more about this effort here.

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