Avalere Analysis Finds 2.4 Million to 3.5 Million New Medicaid Enrollees As a Result of the Affordable Care Act

A new analysis from Avalere Health estimates that from October 2013 through January 2014, between 2.4 million and 3.5 million people have newly enrolled in Medicaid as a result of the Affordable Care Act (ACA).

This includes between 1.3 million and 1.7 million people who newly enrolled in the month of January. (These individuals have been added to Avalere’s original estimates, which included enrollees through the end of December).

“Enrollment of new Medicaid beneficiaries continues in both expansion and non-expansion states,” said Jenna Stento, senior manager at Avalere Health. “Medicaid applications have increased 27 percent on average from October to January compared to application rates before ACA. Application rates in expansion states increased 41 percent over the same period.”

2.4M TO 3.5M NEW MEDICAID ENROLLEES

Reports from the Centers for Medicare & Medicaid Services (CMS) have indicated that at least 8.9 million individuals have been determined eligible for Medicaid between October and January through state Medicaid agencies and state-based exchanges. Another 1.2 million people have been assessed eligible for Medicaid through HealthCare.gov.

Avalere Health developed the estimates by comparing reported data on new enrollments from October through January to enrollment rates from the summer of 2013. Avalere’s estimates include both individuals who are newly eligible for Medicaid as a result of states’ expanding eligibility under the ACA and those who were previously eligible but newly enrolled due to greater awareness of coverage options (also known as the “woodwork” population). Avalere’s estimates remove individuals who would have been enrolled in Medicaid absent the ACA, including eligibility renewals in some states.

“Medicaid enrollment grew quickly in January, now that coverage is in effect and new enrollees can seek healthcare services,” said Caroline Pearson, vice president at Avalere Health. “Additionally, more effective processing of backlogged applications likely contributed to the increased enrollment in January.”

Methodology

For this analysis, Avalere Health utilized data from CMS Medicaid and the Children’s Health Insurance Program (CHIP) enrollment reports and the Assistant Secretary for Planning and Evaluation (ASPE) exchange enrollment reports. We compared the number of new Medicaid and CHIP applications from October through January to the average monthly number of applications submitted from July through September of 2013 (“the control”). We then applied this comparative rate to the total number of determinations, with two sets of assumptions for those assessed/determined by exchanges, which comprise our lower and upper bound estimates outlined below.  

For our lower bound estimate, we compared the number of new applications submitted to Medicaid and CHIP agencies from October through January plus assessments/determinations made by exchanges reported by ASPE over the same period to the control to develop the comparison rate (“lower bound comparison rate”). Then, we applied the control to the sum of total Medicaid and CHIP determinations and individuals assessed/determined eligible for Medicaid and CHIP by the marketplace, excluding state-based exchanges to avoid double counting. We applied the lower bound comparison rate to this figure to calculate new determinations.  

For our upper bound estimate, we compared the number of new applications submitted to Medicaid and CHIP agencies from October through January to the control to develop the comparison rate (“upper bound comparison rate”). We then removed determinations made by exchanges from the Medicaid and CHIP determinations reported in the CMS report and applied the upper bound comparison rate. Lastly, we added all assessments/determinations for Medicaid and CHIP by exchanges, effectively assuming all determinations made by HealthCare.gov result in a determination for a newly enrolled individual.  

Notes

  • This analysis compares activities from October through January to application rates from the summer of 2013. There is some evidence of seasonality in enrollment tends, and this analysis does not control for such fluctuations given data limitations.   
  • While Avalere takes steps to remove double counting, it is possible that some double counting is present as exchanges assess eligibility and then refer such cases to state agencies where determinations are made. In addition, in a limited number of cases, states have reported households as opposed to individual applicants, and this is not adjusted for.  
  • For purposes of this analysis, Avalere treats ID as a federal exchange state given IT reliance on HealthCare.gov. Further, we use the expansion versus non-expansion state designation in the CMS monthly enrollment report.
  • The following states did not report control data for applications submitted; thus, we use the average expansion state rate as a proxy: DE, NY, RI, and WA.
  • The following states do not report Medicaid and CHIP determinations made by exchanges separately as they are processed through the same portal: CO, HI, and MA. Thus, estimates in these states do not treat these populations separately.  

Other state notes:

  • IL did not report Medicaid and CHIP applications in the October CMS report. To adjust, Avalere used a three-month rate calculation for applications.
  • MA did not report Medicaid and CHIP determinations in any month. Thus, applications are used as a proxy, which may overstate the estimate for this state.  
  • PA did not report Medicaid and CHIP applications or determinations in the January CMS report. To adjust, Avalere used a three-month rate calculation for applications and the average of October, November, and December determinations for January.
  • WI did not report Medicaid and CHIP determinations in any month. Thus, applications are used as a proxy, which may overstate the estimate for this state. 

For more information on Medicaid expansion, contact Jenna Stento at JStento@Avalere.com.

View the full Avalere press release attached.

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