Pandemic inflates Medicaid enrollment to 80M people, “high water mark”


The recession caused by a pandemic and a federal requirement that states keep Medicaid beneficiaries enrolled until the end of the national emergency has increased the group of people in the program from more than $ 9 million last year, according to a report published Thursday.

The latest figures show that Medicaid enrollment rose from 71.3 million in February 2020, when the pandemic began in the United States, to 80.5 million in January, according to a KFF analysis of federal data.

There were about 56 million in 2013, just before many states expanded Medicaid under the Affordable Care Act. And it is double the 40 million enrolled in 2001.

Medicaid, once considered the worst duck compared to the politically powerful and popular Medicare program, now covers nearly 1 in 4 Americans. In New Mexico, the ratio is more than 1 in 3.

Together, Medicaid and Medicare cover 43% of Americans.

More than three dozen states since 2014 have used billions of ACA funds to expand coverage beyond traditional Medicaid populations to cover adults with incomes below 138% of the federal poverty level, or about $ 17,800. By the end of 2020, 14.8 million new eligible adults were enrolled in Medicaid through the ACA.

The states that have seen at least an 80% increase in Medicaid enrollment since 2013 are Kentucky (157%), Nevada (129%), Alaska (94%), Colorado (92%), Montana (88%) , Oregon (85%)) and New Mexico (80%).

Although Medicaid has often been criticized for having too few doctors accepting its low reimbursement rates, state officials say they have survived the outbreak with few complaints from writers about accessing health services. One of the main reasons is the dramatic crisis in people seeking medical care during the pandemic because they mitigated their risks of covid contracting. In addition, doctors have been able to adapt to more patients effectively with telehealth appointments after federal rules extended the reimbursement for these services.

“We don’t have access problems,” said Karen Kimsey, Virginia’s Medicaid director. Since March 2020, Virginia Medicaid has added 308,000 members, a 20% increase, state officials say. With the exception of a shortage of some authorized mental health providers, state officials said they have enough providers to handle the increase in demand.

Typically, an increase in enrollment in Medicaid can paralyze state budgets, but a coveted relief package passed by Congress last year has increased the federal portion of its funding for traditional Medicaid by 6.2 percentage points. Prior to the pandemic, Washington paid on average about 56% of Medicaid costs, with the poorest states receiving a larger share of federal funding.

However, the funding resource has asked states not to remove anyone from the program during the public health emergency unless they die or move out of state.

The increase in federal contributions does not apply to enrollment covered by the ACA Medicaid expansion. The federal government already pays at least 90% of its spending.

Among the big winners of the expanded Medicaid rolls are private health plans, which most states use to cover their enrollment. Health plans such as those managed by titans run UnitedHealthcare, Molina Healthcare and Centene Corp. they receive a payment from the States each month based on enrollment. This means that these insurers can profit if they control costs, but lose money if the costs to deal with subscribers are too high.

“We’ve seen plan revenues increase and the use of health services decrease, which is a recipe for increasing profits,” said Massey Whorley, a Medicaid expert with consulting firm Avalere.


Because of the way they are paid, health insurers have benefited economically during the pandemic compared to other major sectors of the health industry, such as hospitals, doctors and nursing homes forced to lengthen budgets for the additional personnel and protective equipment for workers while their revenues decrease due to declining demand.

Most health experts expect the Biden administration to maintain the nation’s health emergency status until at least the end of the year. Administration officials said they will give states at least 60 days notice before the emergency ends so that states can prepare to determine who is still eligible for Medicaid and help those who leave the program transition to other coverage.

“What we’re seeing now is the high water mark for Medicaid enrollment,” Massey said.

Helping guide Medicaid enrollment this year was the Biden administration’s decision to reopen the ACA insurance market from March through August 15th. About 331,000 people who applied as part of that special enrollment were eligible for Medicaid or the Children’s Health Insurance program.

Anthony Fiori, an analyst at consulting firm Manatt Health, said some states were likely to adjust payments to health plans when annual contracts were negotiated to account for a decline in health use. He noted that many states have limits on how much health plans can make in profits.

Matt Salo, executive director of the National Association of Medicaid Directors, said some states have considered reducing the fees paid by insurers per person.

As more people become fully vaccinated, Salo said, states expect an increase in enrollments seeking care they will receive during the pandemic, which will increase costs. “There will be a lot of revolting demand that could explode in the near future,” he said.

Several health plans have told Wall Street investors that the pandemic has been good for their financial health.

Molina CEO Joseph Zubretsky said in April that the company’s Medicaid enrollment at the end of March was 3.9 million members, an increase of 260,000 since December. Since the pandemic began, the company estimates it has added more than 700,000 Medicaid members with no plateau in sight.

“For each month the national covid emergency extends, it would produce about $ 150 million in revenue for our annual total,” he said.

Zubretsky predicted that many would stay on Medicaid longer.

“The economy of low-wage service, sandwich shops, restaurants, dye shops isn’t really going back to square one, and I always think there will be a significant amount of that membership that will be on Medicaid for an extended period of time, ”he said.

KHN is an independent publishing program of KFF.

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