Understanding the Numbers: Medicaid, CHIPS, and the Impact for Hospitals

Medicaid is a safety net for millions of people.

The numbers have been all over the media this past week: More than 80 million people are on the Medicaid and Children’s Health Insurance Program or CHIPS roster. Here are the facts:

• Pre-pandemic, from December of 2017 to July of 2019, the Medicaid roster had declined by 1.1 million adults and about 750,000 children; the total number of enrollees sat at 72.4 million.

• However, COVID shifted the demographics considerably. From the start of the Pandemic, in February 2020 to January 2021 there was a 13.9 percent increase in persons enrolling for coverage by the plans, roughly 9.9 million people.

• Of the 80.5 million people now enrolled, 38.3 million were enrolled in both Medicaid and CHIPS

The recent report by the Kaiser Family Foundation details enrollment patterns with increases across every state. The percentage increases span from 7 percent in Alaska, to 15 percent in Wyoming, upwards of 25 percent in Utah. For point of fact, growth by 17.5 percent equates to approximately an additional 6 million people. Much but not all of the growth is aligned with unemployment rates, currently at about 5.8 percent. However, there is usually a lag between unemployment and Medicaid enrollment growth.

Even as unemployment starts to decline, there may continue to be added numbers to the Medicaid tally.

What does this all mean for hospitals? States that swore to never vote for Medicaid expansion are considering it, such as Kansas and Texas. The Texas Health and Human Service Commission will be conducting a public hearing on July 12 to receive comments on proposed Medicaid reimbursement for rural hospital inpatient services.

Missourians voted to approve expansion last year, and changes were expected to start on July 1. However, the state legislature pulled back the approval in the spring, and a state judge struck down expansion last week. Medicaid expansion would have provided coverage to 275,000 new beneficiaries to the roster in Missouri at an estimated cost of $1.8 million dollars; the majority would have been covered by the federal government. This ruling did not make Centene happy; the major Medicaid insurer is based in Missouri and now considering whether they will stay in the state. Loss of Centene to Missouri would translate to major job and other losses, and only add more people to their state’s the Medicaid roster.

Medicaid is a safety net for millions of people, and solid payment source for a rapidly rising number of people across the US; COVID only amplified access issues to sufficient housing, food, employment, transportation, education, and quality health and mental health care. 

Our Monitor Monday survey asked listeners, what percent of their patients are Medicaid and/or CHIPS recipients; the answers appear here with ongoing impact to every organization’s bottom line.

Programming Note: Listen to Ellen Fink-Samnick’s live reporting on the social determinants of health every Monday during Monitor Mondays, 10 Eastern.