As is the case with Medicaid enrollment generally, it is still early days for assessing the level of migration from Medicaid to the ACA Exchange plans. That doesn't mean we won't try. According to our state level data - and note that states are setting their own schedules on when to begin redetermination so we only have reports for May on about half the states. Notably, high population states like California and New York and not planning to begin their process until July.
Out of a reported baseline enrollment for CHIP and Medicaid of 97M, about 7.2M renewals have been initiated. Of that 7.2M, about 3.7M have been renewed. This amount would include shifts in enrollment from Medicaid to CHIP. Just under 1M people have been terminated for procedural reasons (i.e. not returning pre-populated form) and about 500K have been terminated due to eligibility requirements. The balance of the renewals remain incomplete.
The procedure for people that are determined to be ineligible after completing paper work and, sometimes, submitting an appeal, is that they are to be directed to the ACA exchanges. The administration has launched an "all-hands" campaign to educate former Medicaid enrollees about their options and implemented outreach.
Most enrollment data released by HHS are the results of the open enrollment period that ends in January. Enrollments are generally not effectuated until the first premium is paid in March. The best high frequency data we have is the Treasury Department's monthly disbursements to insurers. It is a useful reference point because premiums are set once a year.
Based on this approach, our estimate for May enrollment is about 14M or about 20% below the snapshot at the end of open enrollment. It is not an extraordinary decline based on historical trends. We should also note that the decline in disbursements for April is more significant in years past. Based on the Treasury's policy of slow walking outlays ahead of the debt ceiling deadline, it may be something that resolves itself.
If the administration's program is working, we should see increases in ACA enrollment particularly for the non-expansion states of Texas and Florida in June and July.
Let me know what you think.
Emily Evans
