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Medicaid and Exchange Enrollment Update – January 2019

This week, our In Focus section reviews updated information issued by the Department of Health & Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) on Medicaid expansion enrollment from the “January 2019 Medicaid and CHIP Applications, Eligibility Determination, and Enrollment Report,” published on April 25, 2019. Additionally, we review 2019 Exchange enrollment data from the “Health Insurance Exchanges 2019 Open Enrollment Period: Final State-Level Public Use File,” published by CMS on March 25, 2019. Combined, these reports present a picture of Medicaid and Exchange enrollment in 2019, representing 72.4 million Medicaid and CHIP enrollees and 11.4 million Exchange enrollees.

Key Takeaways from Medicaid Enrollment Report

  • Across all 50 states and DC, Medicaid and CHIP enrolled nearly 72.4 million individuals as of January 2019.
  • Medicaid and CHIP enrollment is down more than 1.6 million members since January 2018, a 2.2 percent decrease in enrollment.
  • Since January 2018, 13 states saw positive percentage growth in Medicaid and CHIP. No states saw double digit growth. The highest growth was seen in Alaska (5.7 percent); Iowa (2.9 percent); Connecticut (2 percent); South Carolina (1.8 percent); and Georgia (1.5 percent). Maine and Virginia have since implemented Medicaid expansion in January 2019. Idaho, Nebraska, and Utah have passed ballot measures but have yet to implement expansion.
  • Over that same period, 37 states and DC saw a net decline in Medicaid and CHIP enrollment.
  • As of January 2019, national Medicaid and CHIP enrollment is up 14.7 million (25.5 percent) from the “Pre-Open Enrollment” period, defined as July 2013 through September 2013.
  • The top five states in percentage growth of Medicaid and CHIP enrollment since the Pre-Open Enrollment period are Kentucky (101 percent), Nevada (91 percent), Montana (86.4 percent), Alaska (75.4 percent), and Colorado (65.7 percent). All five are Medicaid expansion states.
  • The top five states in percentage growth of Medicaid and CHIP among states that did not expand Medicaid are North Carolina (27.7 percent), Georgia (17.1 percent), South Carolina (15.5 percent), Florida (13.2 percent), and Alabama (12.5 percent).
  • The top five states in total enrollment growth of Medicaid and CHIP are California (4.1 million), New York (848,724), Washington (614,312), Kentucky (612,705), and Pennsylvania (552,361).

Table 1 – Overall U.S. Medicaid/CHIP Enrollment Growth – Pre-Open Enrollment Monthly Average through January 2019

Key Takeaways from 2018 Exchange Enrollment Report

  • Final Exchange enrollments for the 2019 plan year, published in March 2019, showed that Qualified Health Plan (QHP) plans have been selected by 11.4 million individuals across all 50 states and DC.
  • 2019 QHP selections are down over 306,000 from 2018 QHP selections, a decline of 2.6 percent across all 50 states and DC.
  • Only one state saw double-digit percentage growth in QHP selections – Massachusetts (13 percent), a State-Based Marketplace. Ten states saw increases between 0 percent to 10 percent.
  • A total of 17 states saw declines in QHP selections between 0 percent and 5 percent. Another 16 states saw declines of 5 percent to 10 percent. A total of seven states saw double-digit percentage declines in QHP selections from 2018 to 2019.
  • Overall, all Federally-Based administration models saw declines in enrollment, while State-Based Marketplaces saw an increase of 0.9 percent.

Table 2 – Overall U.S. Exchange QHP Selection Growth – 2018 through 2019

The table below (Table 3) provides state-level data on Medicaid and Exchange enrollment.

Medicaid and Exchange Enrollment Data Sources

Link to CMS Medicaid Expansion Enrollment Report:

“January 2019 Medicaid and CHIP Application, Eligibility Determination, and Enrollment Report” (April 25, 2019)

Link to CMS Marketplace Open Enrollment Period Public Use Files:

“2019 Marketplace Open Enrollment Period Public Use Files” (March 2019)