KFF Analysts Find That
Between 5.3 Million and 14.2 Million People Could Lose Medicaid Coverage
Following the End of the Public Health Emergency and Continuous
Enrollment Requirement, With an Unknown Number Able to Find New
Coverage
Medicaid Enrollment is
Expected to Grow By About 25 Percent, or 22.2 Million Enrollees, From FY
2019 Through FY 2022, Mainly Due To Continuous Enrollment Requirement in
Place During COVID
The Enrollment Growth
is Expected to Cost States Over $47 Billion Through FY 2022, But States
Will Have Received $100 Billion to Cover New Medicaid Costs and Provide
Additional General Fiscal Relief
Between 5.3 million and 14.2 million low-income people could lose
Medicaid coverage following the end of the public health emergency and
federal continuous enrollment requirement, KFF researchers find in a new
analysis. We arrive at those estimates after examining two
potential scenarios about how states might manage the resumption of
eligibility redeterminations and disenrollments.
KFF analysts also project that, from fiscal year 2020 through fiscal year
2022, states will have collectively spent $47.2 billion to cover
additional people enrolled in Medicaid because of the continuous
enrollment requirement and will have received $100.4 billion in new
federal funds to cover those costs and provide general fiscal relief
through enhanced Medicaid matching funds.
Based on the analysis, we estimate that enrollment will have risen by 25
percent, to a projected 110.3 million, by the end of fiscal year 2022.
That would be 22.2 million more people than were enrolled in fiscal 2019,
before the pandemic. We attribute most of the increase to the continuous
enrollment requirement that helped to ensure coverage for enrollees
during the pandemic and halted churn or temporary lapses in coverage due
to enrollees cycling on and off the program in short periods of time.
In a recent KFF survey
of state Medicaid directors in the field in February 2022,
state officials projected
that median Medicaid enrollment would decline by 5 percent next year
following the end of the public health emergency. Another KFF survey
from January 2022 found states expect on average about 13 percent of
Medicaid enrollees to be disenrolled following the end of the continuous
enrollment requirement (with estimates ranging from 8% to over 30%).These
recent survey results illustrate the great deal of uncertainty
surrounding how states will implement the end of the continuous
enrollment requirement and how many individuals will lose coverage.
In the new analysis, KFF researchers examine two potential scenarios
based on these survey results, estimating that a 5 percent decline in
Medicaid enrollment would translate into a decline of 5.3 million
enrollees and a 13 percent decline in Medicaid enrollment would translate
into a decline of 14.2 million enrollees. There was a wide range in state
estimates, so in any given state the share of enrollees losing coverage
could be lower or higher than these illustrative estimates.
The biggest losses are expected to be among adults made eligible for
coverage by the Affordable Care Act’s Medicaid expansion, other adults
eligible for Medicaid other than due to a disability, and children, as
these were the groups that experienced the largest increase during the
pandemic. Researchers did not examine how many of the people who lose
Medicaid might be able to find coverage from other sources such as the
ACA Marketplace, how many might become uninsured and how many might still
be eligible for Medicaid but face barriers in retaining coverage.
In exchange for abiding by the continuous enrollment requirement, states
became eligible for a 6.2 percentage point bump in the federal Medicaid
match rate (“FMAP”) to help them manage rising enrollment and rapidly
provide broader fiscal relief by allowing states to reduce state Medicaid
spending at a time when states experienced significant drops in revenue
early in the pandemic.
KFF analysts find that over time states will have received
pandemic-related federal Medicaid money amounting to more than double the
higher state Medicaid costs they have faced due to increased enrollment.
We did not examine how states used the fiscal relief. State spending on
Medicaid is likely to increase following the expiration of the public
health emergency and the loss of enhanced federal funding, even after
factoring in the expected declines in Medicaid enrollment.
States that have not expanded Medicaid under the ACA have tended to draw
more federal fiscal relief than expansion states during the pandemic,
chiefly because the enhanced federal matching money does not apply to the
ACA adult expansion population.
The new analysis uses data from a companion
KFF analysis also released today. In the second analysis, KFF
researchers more closely examine typical Medicaid enrollment patterns
before the pandemic.
The full analyses are:
- Fiscal
and Enrollment Implications of Medicaid Continuous Coverage
Requirement During and PHE and After the PHE Ends
- Unwinding
the PHE: What We Can Learn From Pre-Pandemic Enrollment Patterns
For more data and
analyses related to Medicaid and the pandemic, visit
kff.org.
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