CMS Reports Jump in Eligibility Determinations for Medicaid, CHIP

More than 6.3 million U.S. residents have been determined eligible for Medicaid or the Children's Health Insurance Program through state-run agencies and exchanges from Oct. 1, 2013, until the end of December 2013, according to a report released Wednesday by CMS, CNBC reports (Mangan, CNBC, 1/22).

For the report, CMS officials used partial data from state agencies to calculate the number of eligibility determinations between October 2013 and December 2013 (Adams, CQ HealthBeat, 1/22).

According to CNBC, the report does not include the estimated 750,000 eligibility determinations made through the federal health insurance exchange website (CNBC, 1/22). In addition, the numbers do not provide a breakdown of individuals who were newly eligible for the programs under the Affordable Care Act's Medicaid expansion, those who renewed coverage or those who previously were eligible but had not enrolled (CQ HealthBeat, 1/22).

Specifically, the report showed enrollments in Medicaid and CHIP increased by 20% in December 2013 when compared with November 2013. About 2.3 million U.S. residents were deemed eligible for Medicaid or CHIP in December 2013 (Viebeck, "Healthwatch," The Hill, 1/22).

Further, eligibility determinations were 73% higher than the average between July 2013 and September 2013 in states that have chosen to expand their Medicaid programs under the ACA, compared with a 3% increase in the 25 states that have not expanded their programs (Millman, Politico, 1/22).

HHS Says Data Prove More States Should Participate in Expansion, Others Disagree

In a blog post, HHS officials touted the data as proof that more states should expand Medicaid under the ACA.

They wrote, "The increase in the number of Medicaid determinations across the country is encouraging, but more work is left to do to ensure that the millions of uninsured Americans eligible for these program gain coverage." They added, "Not only is expanding Medicaid coverage helping many people gain health coverage, it's a good deal for states: coverage for newly eligible adult beneficiaries is fully federally paid for under the [ACA] for the first three years, and never less than 90% for the years following" ("Healthwatch," The Hill, 1/22). 

However, Matt Salo, executive director of the National Association of Medicaid Directors, took a more restrained view of the data, saying, "What many people don't read far enough to learn is that this number also can include people in some states who are eligible under pre-expansion -- the woodwork effect -- and whose Medicaid enrollment was simply renewed" (Begley/Morgan, Reuters, 1/22).