BEYOND THE NUMBERS
Medicaid enrollment rose 8.4 percent from February to July as millions of Americans lost their jobs or experienced sharp income losses due to the COVID-19 recession. That’s in the 30 states for which we have data, which if we extrapolate nationwide would mean about 6 million more people enrolled in Medicaid — and likely more, given continued increases in August in states with available data. The growing need for Medicaid coincides with a large and growing state budget crisis, which has already prompted some states to cut Medicaid and will likely prompt more to do so unless the federal government provides more aid to states.
Before the pandemic and recession, Medicaid enrollment was flat or falling in most states. It has risen steadily since then, as the figure below shows.
These data include groups for whom enrollment is generally not responsive to economic conditions, such as elderly people and people with disabilities who are enrolled in both Medicare and Medicaid. Enrollment increases among adults covered through the Affordable Care Act’s Medicaid expansion have been much larger — 12.7 percent through July in the 17 states with expansion enrollment data — with Medicaid providing a safety net as millions of adults have lost jobs or income.
These Medicaid enrollment figures are based on preliminary estimates from state websites, as of September 8. Complete enrollment figures for all states from the Centers for Medicare & Medicaid Services (CMS) are available only through April, but the state-reported data to which we have access largely match the CMS data for the months where both are available.
We included further details and sources in an earlier analysis, which this blog post updates. These are the states for which we now have data, and through which month:
- August: Alaska, Arizona, Arkansas, Iowa, Kentucky, Maine, Minnesota, New Mexico, New York, North Carolina, Oregon, Virginia, and West Virginia;
- July: Colorado, Connecticut, Florida, Illinois, Indiana, Kansas, Maryland, Mississippi, Missouri, Nevada, New Hampshire, New Jersey, Oklahoma, South Dakota, Tennessee, Washington, and Wisconsin;
- June: Massachusetts, Montana, Ohio, Texas, and Utah;
- May: Michigan.
Other data confirm that Medicaid enrollment has grown sharply. Second-quarter financial statements from the major health insurance companies serving Medicaid enrollees — Aetna, Anthem, Centene, Molina, and UnitedHealthcare — all show a significant rise in Medicaid enrollment. And most of these companies note that they anticipate further Medicaid enrollment growth as the full impact of job losses takes hold.
Medicaid enrollment increases typically lag increases in people receiving unemployment insurance or SNAP (food stamp) benefits, because people losing jobs or income often focus on their most urgent needs (like food and rent) first, and because people don’t always lose job-based coverage immediately upon losing a job. During the current crisis, Medicaid enrollment may lag even further, because COVID-19 has persuaded people to defer non-urgent medical visits, which are often an impetus to enroll in coverage, especially since providers can help people apply. That means that Medicaid enrollment will likely continue to grow in the months ahead.
These increases are almost certainly mitigating the large spikes in uninsurance rates that would otherwise occur as millions lose job-based coverage or can’t afford private plan premiums due to the recession. But enrollment growth is also adding to the pressure on state budgets. As states begin to exhaust their options to defer budget cuts, they will likely make deeper and more widespread cuts to Medicaid and other health programs unless federal policymakers provide more funds and maintain strong protections for Medicaid enrollees.