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CCF: Unwinding and Enrollment Tracker
The Georgetown Center for Children and Families (CCF) posts its unwinding data, which is updated frequently. Below is an explanation of each CCF unwinding data tracker and how the data is calculated, collected and analyzed.
Impact of Unwinding on Medicaid Enrollment
Called “What is the impact of unwinding on Medicaid enrollment?,” the primary Medicaid unwinding enrollment tracker shows national and state-by-state overall Medicaid enrollment and Medicaid child enrollment by month, with the first month being when unwinding terminations in the state began.
This tracker uses the most recent monthly data available, which will vary by state. In 31 states, the data source is state administrative data, and in 20 states (including the District of Columbia) for which state administrative data is not available, the data source is preliminary monthly enrollment data reported by the Centers for Medicare and Medicaid Services (CMS). The data sources used for each state are listed here.
In addition, this tracker includes an interactive state-by-state “heat” map showing the number and percentage decline in overall net Medicaid enrollment and in net Medicaid child enrollment in the most recent month for which data is available, relative to the first month of unwinding terminations. Note that net declines in enrollment are driven by several factors that move in different directions. This includes, for example, unwinding disenrollments partially offset by enrollment increases due to new applications and reinstatements/reenrollments of those previously terminated from Medicaid coverage.
All data used in this tracker are available in this downloadable spreadsheet.
Impact of Unwinding on Net Medicaid Child Enrollment
Called “How many children are losing Medicaid?,” the net Medicaid child enrollment tracker shows the national aggregate decline in net Medicaid enrollment among children since unwinding began. The data is the same used for the primary Medicaid unwinding enrollment tracker.
Medicaid Renewal Outcomes by State
Called “What is happening with Medicaid renewals in each state?,” the renewal outcome tracker includes an interactive state-specific chart of unwinding renewal outcomes. The tracker includes:
- Outcomes for ex parte renewal, renewal based on renewal form, determination of ineligibility or procedural disenrollment — for all renewals due
- Outcomes only for renewals that have been completed (i.e., excluding pending renewals)
- Disenrollment outcomes — a determination of ineligibility or procedural disenrollment — as a share of total disenrollments.
This tracker uses the monthly Medicaid renewal outcome data that states are required to report to CMS. However, 25 states publicly post the data they report to CMS or otherwise make it available before CMS releases its renewal outcome data for all states each month. In that case, the tracker uses the most recent data available from states, rather than relying on the CMS monthly release. In the situation where there are discrepancies between what states post and what CMS includes in its monthly release of reported data, the tracker uses the CMS-reported data. Links to the data used in this tracker are available in this downloadable spreadsheet.
Other State Unwinding Information and Data
Finally, CCF continues to collect additional information related to unwinding. The “Medicaid Unwinding, Federal Reporting, Strategies/Policies and Data by State,” page and accompanying detailed spreadsheet include detailed information and links related to state unwinding policies, documents, and information.
KFF: Medicaid Directors Survey Results and Reports on Spending and Programs Amid Unwinding
The Kaiser Family Foundation (KFF) released two new reports this week that look in depth and spending and programs:
These reports build off the 23rd annual budget survey of state Medicaid officials was conducted by KFF and Health Management Associates (HMA), in collaboration with the National Association of Medicaid Directors (NAMD). This year, 48 states (including the District of Columbia) responded to the survey, although response rates for specific questions varied. States completed the survey in the summer of 2023.
Here are a few key takeaways:
- States expect national Medicaid enrollment will decline by 8.6% in state fiscal year (FY) 2024 as state Medicaid agencies continue to unwind pandemic-related continuous enrollment protections. After reaching record high enrollment, these estimates reflect a dramatic year-over-year decline in program enrollment from that high.
- Driven by anticipated changes in enrollment, total Medicaid spending growth (federal and state spending combined) is expected to slow in FY 2024 to 3.4%; however, the state (non-federal) share of Medicaid spending is expected to increase by 17.2% in FY 2024 primarily due to the phase out of enhanced federal Medicaid matching funds (set to expire December 31, 2023.) State spending on Medicaid declined in FY 2020 and FY 2021 due to the pandemic-era enhanced FMAP.
- States reported more rate increases for nursing facilities and home and community-based services (HCBS) providers than for other provider categories, with several states reporting substantial increases – likely in response to ongoing workforce or staffing-related challenges. The majority of states were also implementing rate increases for behavioral health (mental health and substance use disorder) providers and primary care providers.
- Mental health and/or substance use disorder (SUD) services continue to be the most frequently reported category of benefit expansions. States dramatically expanded the use of telehealth during the pandemic, and while telehealth coverage policies have now largely stabilized, states continued to report telehealth coverage expansions in FY 2023 and FY 2024.
KFF: Focus Groups Medicaid Renewal Process
New KFF focus groups look beneath the numbers at the experiences of enrollees who have gone through the Medicaid renewal process. Drawing from five focus groups with adults in Arizona, Florida and Pennsylvania who had their coverage renewed or who were disenrolled, the focus groups probed enrollees’ experiences with Medicaid, awareness of the end of the continuous enrollment provision, experiences renewing their coverage in recent months, and—if they were disenrolled—their efforts to regain Medicaid or transition to other coverage. Insights from focus group participants highlight both where processes are working well and where policies and systems create administrative barriers to maintaining Medicaid coverage for those who remain eligible.
Among the key takeaways:
- Most participants who successfully renewed their Medicaid coverage found the process quick and easy, especially when done online. However, some participants reported barriers to completing or submitting paperwork and faced long processing times. Some also experienced problems with understanding notices and other communications from the states, as well as challenges getting through to call centers.
- Participants who were disenrolled lost their coverage for a variety of reasons, and some did not know why they had been disenrolled. Several said they did not receive any notices from the state and did not realize they had lost their coverage until they went to fill a prescription.
- Participants said Medicaid enables them to access health care services, mental health services, and medications for themselves and their children with limited out-of-pocket costs and often keeps them healthy enough to work. Awareness that Medicaid coverage had been protected during the pandemic and that disenrollments had begun again in their state varied among participants.
- Many participants said that losing Medicaid would be harmful due to loss of access to needed prescriptions and treatments. They believed that losing Medicaid would cause a serious decline in their physical and mental health and expressed anxiety at the thought of no longer having Medicaid coverage for themselves or their children.
As unwinding continues, these enrollee experiences can help inform policymakers about opportunities to improve communication and outreach, simplify notices, provide assistance with renewals including through call centers, and help enrollees who were disenrolled regain Medicaid if eligible or transition to other coverage if no longer eligible.
Over six months after the expiration of pandemic-era enrollment protections, at least 27 million Medicaid enrollees—or roughly one-in-three enrollees across the country—have completed their state’s eligibility renewal process for the program. Over 18 million people have had their coverage renewed, and over 10 million have been disenrolled, as of November 8, 2023.
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