Fact sheet

Medicaid & CHIP: March 2014 Monthly Applications, Eligibility Determinations, and Enrollment Report

Medicaid & CHIP: March 2014 Monthly Applications, Eligibility Determinations, and Enrollment Report
May 1, 2014

Overview
Today the Centers for Medicare & Medicaid Services (CMS) is announcing more than 4.8 million additional individuals enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) from October 1, 2013 through the end of March 2014, compared to enrollment before the Health Insurance Marketplace opened on October 1, 2013.  This announcement comes as part of the release of the sixth in a series of monthly reports on state Medicaid and CHIP data, and represents state Medicaid and CHIP agencies’ eligibility activity for March 2014, which coincided with the last month of the Health Insurance Marketplace Open Enrollment.  This report includes state data and analysis on applications to Medicaid and CHIP agencies and the State-Based Marketplaces, eligibility determinations made by these agencies, and state data on total enrollment in the Medicaid and CHIP programs.  

CMS is also reporting that, due to a new option under the health law, approximately 1 million additional individuals gained coverage through early expansion of Medicaid programs in seven states before January 1, 2014.  While open enrollment is over for the Marketplace, Medicaid and CHIP signups continue.

Key Facts:

• More than 4.8 million additional individuals enrolled in Medicaid or CHIP from October 1, 2013 through the end of March 2014 compared to enrollment before the Health Insurance Marketplace opened.  
• Another approximately 1 million individuals gained coverage through an early expansion of Medicaid to low-income adults in seven states before January 1, 2014.  

Background on Data
In earlier reports, CMS presented the number of people determined eligible for Medicaid and CHIP by their state Medicaid agencies and through state-based Marketplaces each month, and also cumulatively since the beginning of open enrollment.  The March 2014 report shows 4.8 million additional individuals were enrolled in these programs compared to the period prior to first Marketplace open enrollment period (July - September 2013) (an increase of over 1.8 million individuals over the gain reported for February).  The total enrollment data is a point-in-time count of all individuals enrolled in the Medicaid and CHIP programs, and is unduplicated.  

CMS arrived at the total enrollment number by taking the difference between the total Medicaid and CHIP March 2014 enrollment numbers for those states (including the District of Columbia) that reported both March monthly data and data from the period prior to the start of Marketplace Open Enrollment.  In those 47 states, enrollment was 63,679,689 at the end of March, compared to 58,855,645 in the period prior to the start of Marketplace Open Enrollment in October 2013.

It is important to note that the enrollment numbers reported today underreport what the actual enrollment for March 2014 will ultimately be.  There are several reasons for this:

• Not all states are reporting (March data is missing from two states, and 2 additional states are missing July through September 2013 data).
• The data are preliminary, and do not include individuals who will later be found eligible for retroactive Medicaid coverage effective in March 2014.  In most states, Medicaid coverage can be retroactive for up to 90 days from the date of application.

It is also important to note that this data is not comparable to our count of individuals determined eligible in March 2014 or cumulatively over the open enrollment period.  In February 2014, that cumulative number of determinations was 11.7 million people, and in March 2014, that number rose to 14.7 million people determined eligible for Medicaid and CHIP.  There are several key reasons why the new total enrollment numbers are different from eligibility determinations:

• The enrollment numbers only include individuals eligible for full benefits coverage while the determinations numbers include individuals receiving all types of coverage (for example, individuals only eligible for help paying their Medicare premiums).  
• The enrollment number in this report represents unduplicated individuals enrolled in the programs.  Determination numbers are not an unduplicated count and some states included renewals.
• Enrollment numbers—unlike the determination numbers—reflect coverage losses as well as coverage gains.  Some individuals who were previously eligible for Medicaid are now eligible instead for Marketplace coverage or job-based coverage, for example.

Finally, it is important to note that Medicaid enrolls eligible individuals all year long and the close of the first Marketplace open enrollment period has no impact on individuals’ ability to apply for, and enroll in, Medicaid.

Future Reporting
All 50 states and the District of Columbia are in the process of implementing the Affordable Care Act simplifications to the Medicaid and CHIP application for enrollment.  They are also carrying out Affordable Care Act simplifications for eligibility determination processes, as well as making technology upgrades to transition to streamlined, data-driven eligibility determination systems.  As states shift to these new eligibility and enrollment systems, we will continue to see improvements in reporting capacity.