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How Did COVID Push Medicaid to Record Enrollment?

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A record 80.5 million Americans have health coverage through Medicaid or the Children's Health Insurance Program, largely because states have had to keep people enrolled during the coronavirus pandemic, according to new federal data released Monday.

Medicaid posted record enrollment in 2020, jumping by 9.7 million people to nearly 74 million Americans, according to the Centers for Medicare and Medicaid Services.  That’s an increase of 15.2%.

CNN’s recent article entitled “Pandemic pushes Medicaid enrollment to record high” reports that all states saw jumps in their Medicaid enrollment, ranging from 7% in Alaska to 25% in Utah, according to the Kaiser Family Foundation.

In contrast to the Trump administration, which sought to limit Medicaid participation by adding additional requirements, the Biden administration is looking to increase coverage by making it easier to enroll. CMS has already started unwinding some of the efforts of the previous administration, including allowing states to institute work requirements. President Biden also added a special enrollment period for the federal Affordable Care Act exchanges, which runs from mid-February to mid-August. More than 331,000 people seeking coverage were found to be eligible for Medicaid or CHIP, though May.

CMS Administrator Chiquita Brooks-LaSure said that the agency will continue to encourage states to take advantage of the incentive and to work with the agency on waivers, if they want to tailor their programs.

“We’re going to continue to point out to states that we want to offer them flexibility as they come on board,” Becerra said. “We’re hoping that the other states that haven’t gotten there will recognize that they’ve got millions of residents who could qualify for good, quality care and would no longer need to use the emergency room as their point of primary care services, which makes it the most expensive way to get care.”

An additional four million people could potentially gain access to Medicaid, if all states expand. Some of those signing up for Medicaid became eligible after losing their jobs amid the pandemic’s economic upheaval. However, a lot of the increase is attributable to a provision in an early coronavirus rescue deal Congress passed in March 2020, CMS said. Congress approved a temporary 6.2 percentage point increase in the federal matching rate for states. Therefore, states must maintain continuous coverage for current Medicaid enrollees and are prohibited from making eligibility or enrollment more restrictive than prior to the pandemic. The provision will remain in place, as long as the federal public health emergency is in effect.

There’s usually a big churn in the Medicaid program because of the fact that the participants’ income increases, or they encounter administrative hurdles to reenrollment. For the two years prior to the pandemic, Medicaid enrollment had dropped by about 2.2 million people (3%) amid the robust economy and some states’ tightening of eligibility verification and renewal requirements. In the pandemic, federal aid and stronger-than-expected revenues helped states avoid cutting payments to Medicaid providers. States instead focused on maintaining access to physicians and hospitals, which were struggling as patients stopped going to doctors and hospitals for more routine care during the pandemic. States were trying to retain providers and make sure they were staying solvent, with dropping demand.

Reference: CNN (June 21, 2021) “Pandemic pushes Medicaid enrollment to record high”

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