CMS' split personality regarding Medicaid unwinding was on display yesterday as SecHHS released certain snapshot data on enrollment of children in Medicaid. The federal government has concluded that certain policy choices are to blame for significant disparities between states' disenrollment data. They point out especially states that did not expand Medicaid like Texas and Florida.
As of September, according to CMS, about 88.5M adults and children are enrolled in Medicaid. This amount is about 17.5M more than pre-public health emergency levels even though the enhanced match of 6.2% that has been in place since 2020 expires at the end of this month.
CMS has urged states to use a number of tools available to it to retain child enrollees, including expansion.
As we have pointed out previously, the goal of the administration is to keep the uninsured rate at its current low levels. They have gotten plenty of support, much of it unintentional, from states reliably in their base like New York, which did not begin disenrolling until July. The word around town is many states, especially those that have expanded their eligibility to include childless adults, were not prepared with the data systems necessary to move quickly once the end of the Public Health Emergency was declared.
Their lack of preparation likely springs from a lack of urgency . The federal government match for expansion beneficiaries is 90%, a powerful incentive to classify as may people as expansion as possible. States like Florida and Texas, which did not expand under the ACA, must contend with a much lower federal match of about 50%.
The question for us is how long states will drag their feet. The Office of the Inspector General will eventually demand evidence that the post-PHE enrollments are legitimate. As they have in the past, they are also likely to revive the incentives presented by the higher match for childless adults. In the meantime, more coverage is good for providers.
Emily Evans
Managing Director – Health Policy
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