Medicaid and the Children’s Health Insurance Program is expected to have nearly 95 million enrollees by the end of March, representing an increase of 23.3 million enrollees since the start of the pandemic, a new analysis discovered. 

The Kaiser Family Foundation report comes as states prepare for the end of the continuous enrollment provision, set to expire March 31. This provision was put in place through the Families First Coronavirus Response Act and barred states from disenrolling Medicaid members during the Covid-19 public health emergency. However, the Consolidated Appropriations Act signed into law in December separated the provision from the public health emergency and set the end date of March 31.

Because states could not disenroll members, it stopped what’s referred to as “churn” — when members disenroll and then re-enroll in Medicaid. It is estimated that when the provision ends, about 15 million people could lose coverage, according to the U.S. Department of Health and Human Services.

“The continuous enrollment provision halted disenrollment and churn, resulting in overall program growth. While states will need to conduct renewals for all enrollees, understanding the overall growth in enrollment and the composition of that growth can help inform understanding the range of potential outcomes as the continuous enrollment unwinds. How individual states implement the unwinding will affect the ultimate loss of coverage,” KFF said.

The increase of 23.3 million Medicaid members (representing one in four of all members) includes 8.9 million adults in the Affordable Care Act Medicaid expansion group, 1.3 million adults eligible based on disability or age, 5.8 million other adults, 7.3 million children under 19 and 0.2 million CHIP enrollees. CHIP had low rates of enrollment growth because the continuous enrollment requirement is not applicable to separate CHIP programs, according to the report.

“It is expected that the groups that experienced the most growth due to the continuous enrollment provision — ACA expansion adults, other adults, and children — will see the largest enrollment declines,” KFF stated.

Most of the enrollment growth came from a small group of states that have large populations and Medicaid programs: California, New York, Texas, Florida and Illinois are responsible for more than one-third of Medicaid enrollment growth. In addition, states that expanded Medicaid after 2020 had high enrollment increases. This includes Oklahoma, Missouri, Nebraska, Utah and Idaho.

“Actual enrollment outcomes will vary across states depending on an array of state policy decisions including how states prioritize renewals and efforts to conduct outreach and enrollment assistance,” the report said. “These policies can help ensure that those who remain eligible for Medicaid are able to retain coverage, and that those who are no longer eligible can transition to other sources of coverage, particularly the ACA marketplace.”

Several health plans are implementing campaigns to get the word out about the return to the typical renewal process, including L.A. Care Health Plan and Health Net. About 64% of Medicaid members are unaware about pending redeterminations, the Robert Wood Johnson Foundation discovered.

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