ACA Now

Implementation Status

2012

The June 28, 2012 Supreme Court ACA ruling effectively rendered the Medicaid expansion provisions under the law at state option.  In the wake of the ruling, the Administration confirmed that states may not partially expand their Medicaid programs (i.e., less than the 133% threshold called for under the law) and draw down the ACA-enhanced federal funds.  CMS also confirmed that, if a state covers the expansion group, it may decide later to drop the coverage (e.g., during the period in which the federal contribution is phased-down).  Following the ruling, in the late summer 2012, the GAO issued a report examining states efforts to implement the ACA Medicaid expansion.  The Administration continues to move forward to issue final Medicaid regulations and provide additional guidance to states pursuant to the ACA.  For the latest on CMS’ Medicaid expansion efforts, including relevant regulations and guidance issued to date, see here and here.

2013

On January 14, 2013, CMS issued a proposed rule regarding, in part, Medicaid eligibility rules, appeals processes, EHBs and eligibility categories. CMS also posted an informational bulletin regarding the rule. The comment deadline was February 13.

On January 14, 2013, HHS sent a letter to Governors Jack Markell (D-DE) and Mary Fallin (R-OK), Chair and Vice-Chair, respectively, of the National Governors Association (NGA), regarding state flexibilities under the ACA to design their respective Medicaid programs.

On January 16, 2013, CMS issued a SHO/SMD letter regarding the applicability of mental health parity requirements to Medicaid alternative benefit (benchmark) plans.

On February 20, 2013, CMS issued a final rule defining the core package of EHBs that health insurance issuers must cover in individual and small group products offered inside and outside of Exchanges. We note the intersection with this regulation and the minimum standards set forth with respect to Medicaid benchmark benefit packages.

On February 6, 2013, CMS issued a FAQ document that, in addition to addressing the BHP option (as discussed in Title I), clarified provisions relating to the newly eligible and expansion state FMAP; transition to MAGI; and coverage of certain populations, including pregnant women and children (including former foster care children up to age 26).

On February 20, 2013, CMS issued an informational bulletin to inform states of the verification plans required for both Medicaid and CHIP eligibility, the MAGI-based Eligibility Verification Plan Template, and a review of the final verification regulations.  As stated in the informational bulletin, CMS requested that states submit their MAGI-based eligibility verification plans by March 20, 2013.

In a related event, on February 21, 2013, CMS issued a new report titled, “Medicaid Moving Forward,” which outlined “recent developments, opportunities available to states today, and upcoming activity that will help states improve and modernize their Medicaid programs,” among other topics, CMS indicated.

On March 29, 2013, CMS issued a final rule for comment codifying the availability of the enhanced FMAP for states that elect to expand their Medicaid populations pursuant to the ACA, specifying the conditions by which (including the threshold methodology).  A CMS fact sheet is available here.  Comments are due by June 5. 

On March 29, 2013, CMS issued a FAQ document providing guidance on using Medicaid funding to enable beneficiaries to purchase Qualified Health Plans (QHPs) in the Exchange.  In sum, the document suggests that while states likely have flexibility to quantify savings in an array of potential areas – as Arkansas already has taken steps to project – the federal government will not otherwise foot the bill for the delta between Medicaid and private coverage for individuals below 100% of the Federal Poverty Level under these arrangements.  At the same time, CMS implies that more federal funding may be available for those above 100% FPL, because they otherwise would qualify for premium tax credits through Exchange coverage.  This document also addresses related provisions regarding individual market premium assistance demonstrations per the existing section 1115 waiver authority.

In a related event, on May 10, the Government Accountability Office (GAO) issued a report entitled, “Alternative Measures Could Be Used to Allocate Funding More Equitably.”  Among their findings, the GAO concludes that multiple data sources were identified that could be used to develop measures to allocate Medicaid funding to states more equitably than the current funding formula – the Federal Medical Assistance Percentage (FMAP) – which is based solely on per capita income (PCI).   GAO recommends that a funding allocation mechanism should take into account the demand for services in each state and geographic cost differences among states, while also ensuring that taxpayers in poorer states are not more heavily burdened than those in wealthier ones.

On May 17, CMS issued a State Health Official letter titled “Facilitating Medicaid and CHIP Enrollment and Renewal in 2014.”  The letter offers optional strategies that states can employ to reduce the number of uninsured individuals, as well as optional tools to help states manage the transition to their new eligibility and enrollment systems and coverage of new Medicaid enrollees for 2014.  The letter describes five specific targeted enrollment strategies and provides guidance for states interested in adopting them, including implementing early adoption of the Modified Adjusted Gross Income (MAGI)-based rules.

On June 21, CMS unveiled a new Medicaid and CHIP Repository for 2014 State Plan Amendment (SPAs) filings. Among other things, states are filing SPAs to implement new MAGI-based eligibility levels, elect a streamlined application format and indicate alternative benefit plan (ABP) designs for adults. Additional instructions and background information are available at the new repository landing page here.

Note that on June 28, 2013, HRSA issued a grant entitled, “(HRSA-13-281) Supporting the Continuum of Care: Building Ryan White Program Grantee Capacity to Enroll Eligible Clients in Affordable Care Act Health Coverage Programs,” which aims to expand coverage to Persons Living With HIV and AIDS (PLWH) including through new coverage options under the Medicaid expansion and Exchanges.  Applications were due July 29.  Details here.

In another related event, on July 22, 2013, CMS issued an information collection regarding a new information collection pertaining to the implementation of a Nationwide Consumer Assessment of Healthcare Providers and Systems (DCAHPS) Survey for Adults in Medicaid.  Per CMS, “the survey will serve as baseline information on the experiences of low-income adults during the early stages of implementation [of section 2001 of the ACA] that permits states to expand eligibility to adults with income below 138 percent of the federal poverty level who were not previously eligible.”  CMS invites public comments on this information collection by September 20, 2013.

On July 5, CMS issued a final rule implementing a number of ACA Medicaid eligibility, benefit and premium and cost sharing provisions, among others related to Exchanges, while explicitly noting a focus only on those “most critical for implementation” by January 1, 2014, and thus deferring the finalization of other proposals from a January 22, 2013, proposed rule – such as Exchange eligibility appeals, proposed CHIPRA provisions, Exchange certified application counselors and coordination of SHOPs with individual market Exchanges – to future rule-making.

On August 9, 2013, CMS released FAQs related to these provisions of the law, with particular focus on telephonic applications; Medicaid and CHIP Eligibility Policy; and 75/25 Federal Matching Rate.  On August 15, CMS issued a letter to states (also see an accompanying bulletin), acknowledging the ACA-driven modifications in Medicaid and CHIP eligibility processes beginning in 2014 that will necessitate new approaches to measuring eligibility accuracy.  As such, CMS indicated it is implementing in place of the Payment Error Rate Measurement (PERM) and the Medicaid Eligibility Quality Control (MEQC) programs an “annual 50-state pilot program strategy with rapid feedback for improvement” beginning on January 1, 2014, for FYs 2014-16.

On August 9, SAMHSA issued a 10-part technical assistance report, Medicaid Handbook: Interface with Behavioral Health Services, that broadly examines Medicaid’s role in financing mental health and substance abuse care.  Several “modules” that comprise the handbook – which span such topics as Medicaid State Plans and behavioral health service providers – relate to ACA implications; for example, the Medicaid expansion under section 2001; health home initiatives under section 2703; and Accountable Care Organizations under section 3022.

On October 4, CMS issued a new information collection entitled, “Nationwide Consumer Assessment of Healthcare Providers and Systems (DCAHPS) Survey for Adults in Medicaid.”  According to CMS, “the survey will serve as baseline information on the experiences of low-income adults during the early stages of implementation of the [ACA] provision that permits states to expand eligibility to adults with income below 138 percent of the [FPL] who were not previously eligible.”  Comments on the underlying survey are due by November 4.

Also, in mid-October, CMS posted an interactive online map detailing state Medicaid and CHIP policies for 2014, including links to state-specific pages aggregating 2014 Medicaid and CHIP policy documents, such as states’ single, streamlined application for enrolling in Medicaid, CHIP and Marketplace coverage, which may vary from HHS’s model; “consumer experience profiles” that summarize states’ application, enrollment and consumer assistance functions; Medicaid and CHIP verification plans; MAGI conversion plans; and approved Medicaid and CHIP SPAs.  Also see CMS’ National Tables within its broader “Medicaid Moving Forward 2014” resources.

On September 30, CMS issued a series of Q&As explaining the ACA’s new MAGI eligibility standard for Medicaid and CHIP.  Also, in October, CMS CMS posted detailed information on Medicaid and CHIP eligibility levels based on MAGI (see here); a chart showing states’ Marketplace model and – for states with Federally Facilitated Marketplaces (FFMs) – whether the state has delegated Medicaid and CHIP eligibility determination authority to the FFM (see here); a state-by-state eligibility verification policies chart (see here); and a grid of states’ “targeted enrollment strategies” (see here). Also see CMS’ National Tables within its broader “Medicaid Moving Forward 2014” resources.

On Nov. 8, HHS and DOL issued a final rule on mental health parity implementing the MHPAEA.  The Departments note that “these final regulations do not apply to Medicaid managed care organizations (MCOs), alternative benefit plans (ABPs) or the Children’s Health Insurance Program (CHIP),” while adding that “MHPAEA requirements are incorporated by reference into statutory provisions that do apply to those entities.” The rule references a January 2013 State Health Official Letter on the topic in which “CMS adopted the basic framework of MHPAEA and applied the statutory principles as appropriate across these Medicaid and CHIP authorities.”  A set of  FAQs was issued.  See also two related reports here and here.  A SAMHSA inter-agency stakeholder briefing was held on Nov. 8; see webcast here. Additionally, a press release from HHS is available here.

On December 10, 2013, House GOP lawmakers wrote to state Medicaid directors requesting data on the impact of the law on their state Medicaid programs, including: the percentage of practicing physicians accepting new Medicaid patients; details on waiting lists associated with active Sections 1115 of 1915(c) waivers; average wait times for eligible Medicaid individuals currently on a state waiting list; income level ranges for individuals on state’s waiting lists; and an estimate of newly-eligible individuals who would require the institutional level-of-care provided in HCBS waivers. Responses were requested by December 31, 2013. Also, in December 2013, CMS posted information to Medicaid.gov here under “Medicaid Moving Forward 2014,” which includes, among other things, a description of the Medicaid/CHIP eligibility verification policies states are adopting; and a listing of the states that are employing new targeted enrollment strategies to smooth the path to Medicaid and CHIP coverage in 2014. See here.

Note that October 2013 Medicaid and CHIP monthly application and eligibility data (as of December 3, 2013) are available here. The November 2013 Medicaid and CHIP monthly application and eligibility data (as of December 20, 2013) are available here. The December 2013 Medicaid and CHIP monthly application and eligibility data (as of January 22, 2014) are available here. In guidance released on November 29, 2013 regarding new flexibility extended to states to use account transfer flat files transmitted by the Federally Facilitated Marketplace (FFM) to enroll individuals in Medicaid and CHIP, addresses the interactions of this new flexibility with the mandatory transition to MAGI.

On December 27, 2013, CMS issued a set of FAQs addressing questions regarding ACA funding for the new adult group, coverage of former foster care children, and CHIP financing questions.

In December 2013, CMS posted information to Medicaid.gov here under “Medicaid Moving Forward 2014,” which includes, among other things, MAGI-based Medicaid and CHIP eligibility levels by state (see here).

2014

On February 28, 2014, CMS announced that between Oct. 1, 2013, and Jan. 31, 2014, state agencies determined 8,933,378 individuals to be eligible for Medicaid and CHIP. Of those eligibility determinations, 2,436,879 were in January 2014 (about 1.5 million in states expanding Medicaid and 0.9 million in states not expanding). This includes those newly eligible under ACA-authorized expansion, as well as existing eligibles and, in some states, renewals. The agency also indicates that “the determination number does not represent unique individuals, as an individual may have more than one eligibility determination,” among other caveats. State-by-state application and eligibility data for January begins on p. 5 of the report. Updated versions of previously issued reports are available here, under the “eligibility data” tab.

In guidance issued on March 31, CCIIO said that those applying for coverage during Marketplace open enrollment who are determined eligible for Medicaid or CHIP will not face individual mandate penalties for the months in 2014 leading up to their coverage effective dates. The agency indicates that those found to be eligible for Medicaid would qualify for the short coverage gap exemption from the mandate because Medicaid coverage would be effective on the application date, if not before. CCIIO adds that for CHIP, it is “exercising its authority to extend the hardship exemption” applicable to Marketplace enrollees (see Oct. 28, 2013, guidance), given that CHIP coverage effective dates do not necessarily coincide with application dates. Specifically, CCIIO elaborates, the “IRS and Treasury Department intend to publish guidance allowing an individual to claim a hardship exemption from the individual shared responsibility payment for the months in 2014 prior to the effective date of the individual’s CHIP coverage if the individual submits a coverage application prior to the close of the open enrollment period and is found eligible for CHIP.” On April 4, for the first time in its monthly Medicaid and CHIP reports, CMS included an estimate (report; blog post) of approximately 3 million having gained Medicaid or CHIP coverage through February 2014, compared with levels before Health Insurance Marketplaces were implemented on Oct. 1, 2013. The results reflect the change in state-reported Medicaid and CHIP enrollment between July-September 2013 – a baseline period prior to Marketplaces’ open enrollment – and February 2014 in 46 states and D.C. CMS said the increase reflects both newly eligible beneficiaries in states expanding Medicaid, as well as those who previously were eligible, including in states not expanding Medicaid. The aggregate Medicaid and CHIP enrollment figures were reiterated as part of a broader ACA enrollment announcement on April 17. In late April, CMS posted the 2013 Actuarial Report on the Financial Outlook of Medicaid, available here.

On May 1, 2014 HHS announced updated ACA enrollment data as of March 31, as well as others obtaining special enrollment periods through April 19. According to an updated Medicaid and CHIP enrollment report released in tandem with the broader Marketplace-focused update, 4.8M additional individuals enrolled in Medicaid and CHIP compared to before October 2013 (reflecting those in the newly and existing eligible groups). CMS also notes that “another approximately 1 million individuals gained coverage through an early expansion of Medicaid to low-income adults in seven states before January 1, 2014.” An agency fact sheet is posted here on the Medicaid and CHIP data, providing additional context. State-level tables highlighting Marketplace enrollment-related information are available here.

On a related note, on May 12, CMS issued a fact sheet highlighting the availability of new resources under its Connecting Kids to Coverage National Campaign to remind parents and other stakeholders of the opportunity to enroll eligible children, year round, in Medicaid and CHIP. A full listing of these resources – which include free print materials, Public Service Announcements, and social media-related ideas – are available here.

On June 4, CMS posted updated Medicaid and CHIP enrollment data for the month of April 2014. As of the latest data, enrollment under the programs continues to grow, with roughly six million more Medicaid and CHIP enrollees as compared to the period immediately preceding the initial open enrollment period under the ACA.

On July 1, CMS issued fact sheets to assist consumers in understanding their coverage options under Medicaid and CHIP. On July 11, HHS announced in a new Medicaid Moving Forward report (additional details here) that, as of last May, enrollment under Medicaid and CHIP grew by roughly 6.7 million individuals – or roughly 11.4% compared to the July-September 2013 baseline period.

On August 8, CMS released monthly data on Medicaid and CHIP enrollment for June 2014. Data indicate Medicaid/CHIP enrollment is up by 7.2 million, compared to July-September 2013 (the pre-Marketplace open enrollment baseline period) in 48 states reporting both data points (excluding CT, ME, ND).

On August 27, HRSA’s Office of Rural Health Policy (ORHP) announced the availability of (non-competitive) expansion supplemental funds to support existing Small Health Care Provider Quality Improvement program grantees. Under this program, funds will be used by grantees to, among other things, “increase the number of uninsured individuals enrolled into the Health Insurance Marketplaces or other available sources of insurance, such as Medicaid and the Children’s Health Insurance Program.”

On Sept. 3, CMS issued a press release highlighting new data published by the agency in Health Affairs highlighting the decline in the projected number of uninsured – from 45 million in 2012 to 23 million in 2023 – due to the ACA coverage expansions.

On a related note, on Sept. 16, CMS issued an informational bulletin on the “timeframes and requirements for amending Medicaid Alternative Benefit Plans (ABPs).” The guidance addresses situations in which “states are in full or partial alignment between the ABP benefit package and the state’s approved Medicaid state plan package for other categorically or medically needy eligible” while relaying updates about “expectations for public and tribal notification [and] the system to use for state plan amendment (SPA) submissions.”

On Sept. 22, CMS reported that over 67 million individuals were enrolled in Medicaid and CHIP at the end of July 2014 (including new and existing eligible individuals in expansion and non-expansion states).

In its Oct. monthly update, CMS announced(detailed enrollment report) that approximately “8.7 million additional Americans now have coverage through Medicaid and CHIP” since the beginning of open enrollment in August of last year. Medicaid has more than 67.9 million enrollees as of August 2014. The new numbers demonstrate roughly a 15 percent increase over the average monthly enrollment for July through September 2013.

On Nov. 19, HHS announced that Medicaid and CHIP enrollment increased by roughly 9.1 million individuals. A detailed monthly enrollment report is available here.

On a related note, on Dec. 9, in response to a Congressional request to assess the adequacy of access to care for Medicaid managed care enrollees, the OIG released a report (full report here; summary here) titled, “Access to Care: Provider Availability in Medicaid Managed Care.” The report focuses on the availability of providers for enrollees and specifically examines whether providers accepted new patients, as well as patient wait times for an appointment. In its report, the OIG recommended that CMS work with states to address: timely access to providers, accuracy of plan information, network adequacy in light of enrollee needs, and plan compliance to existing state standards.

On Dec. 18, CMS released updated Medicaid and CHIP enrollment figures (detailed data; blog post) for the month of Oct. 2014. According to the latest figures, an estimated 9.7 million additional individuals enrolled in Medicaid and CHIP during the month of Oct. – a 17% leap from the Jul.-Sept. 2014 monthly enrollment baseline period prior to Marketplace open enrollment. State-specific monthly enrollment data begins on p. 9 of the enrollment report. Additionally, CMS noted that, as of Oct. 2014, 26 states plus DC opted to expand Medicaid pursuant to the ACA – and, in Jan. 2015, the addition of Pennsylvania will make 27 states (plus DC). HHS also points to the administration’s recent release of broader data on increasing coverage trends, which “show that the drop in the nation’s uninsured rate so far this year is the largest over any period since the early 1970s.”

2015

On a related note, on Jan. 23, 2015, CMS issued state-reported (unduplicated) Medicaid enrollment figures – data, available here, that states began reporting via the Medicaid Budget and Expenditure System (MBES) beginning on Jan. 1, 2014. The quarterly enrollment figures – spanning the Jan.-Mar. 2014 period – “identif[y] the total number of Medicaid enrollees and, for states that have expanded Medicaid, provides specific counts for the number of individuals enrolled in the new adult eligibility group, also referred to as the ‘VIII Group.’” CMS notes further that the report “include[s] state-by-state data for this population as well as a count of individuals whom the state has determined are newly eligible for Medicaid.” CMS plans to “post the enrollment data for subsequent quarters in the upcoming months.” For additional details, see here.

Of note, on Feb. 23, CMS released updated monthly Medicaid and CHIP enrollment figures (detailed data; and blog post) for the month of December 2014. According to the latest figures, nearly 10.8 million additional individuals enrolled in Medicaid and CHIP during the month of December 2014 – an 18.6% leap from the July-September 2013 pre-Marketplace open enrollment timeframe. Nov. 2014 monthly Medicaid and CHIP enrollment figures were also made available earlier in the month (detailed data; blog post). Also in late Feb., CMS issued an extension of an existing information collection pertaining to the agency’s assessment of Medicaid eligibility changes under the ACA.

On Mar. 16, ASPE released an analysis estimating that 16.4 million uninsured individuals have gained health insurance as a result of ACA coverage provisions since 2010. The report also examines coverage gains among ethnic and minority populations and among young adults. Technical notes on ASPE’s analysis are available here.

On Mar. 20, HHS announced that Medicaid and CHIP enrollment increased by about 11.2 million as of Jan. 2015, or roughly 19% since the Exchanges opened. See also: report and fact sheet.

On Mar. 23, ASPE released two fact sheets highlighting the economic impacts of Medicaid expansion and uncompensated care since the ACA’s passage; see here and here, respectively.

On Mar. 27, GAO released a study (highlights) comparing coverage and cost-sharing among selected CHIP plans and Marketplace QHPs. The five-state study was conducted in Colorado, Illinois, Kansas, New York, and Utah.

On Mar. 30, GAO released a report contemplating the effect of CHIP on children’s health coverage and access, while outlining key issues for the Congress to consider as part of deliberations pertaining to an extension of federal CHIP funding.

On a related note, on Apr. 6, CMS issued a proposed rule extending the application of certain provisions of the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) to coverage offered by Medicaid managed care organizations (MCOs), Medicaid Alternative Benefit Plans (ABPs), and CHIP. A press release on the proposed rule is available here and a fact sheet here. Comments on the proposed rule are due by Jun. 9.

On Apr. 10, CMS released quarterly Medicaid data, finding that as of Sept. 30, 2014, there were 57,035,961 Medicaid enrollees and 4,608,540 newly eligible adults stemming from the ACA-authorized expansion.

On May 1, CMS released a report indicating that 11.7 million people have enrolled in Medicaid or CHIP through the ACA as of the end of Feb. 2015. An additional 11.7 million persons have enrolled in coverage through an Exchange.

On June 22, CMS issued an extension of a currently approved information collection titled, “Medicaid Program Eligibility Changes under the Affordable Care Act of 2010.” The data collection pertains to the electronic transmission and automation of data transfers relative to insurance affordability programs.

On June 23, CMS released a report detailing Medicaid & CHIP applications, eligibility determinations, and total current enrollment for April 2015. Based on this latest data, total enrollment in Medicaid and CHIP was over 71 million – nearly 77,000 more than in March 2015 (for which data was released on June 4) in states reporting comparable data and over 12 million (21.3% increase) than the July-Sept. 2013 baseline.

On June 23, CDC released initial statistics regarding the rates of insured/uninsured in 2014, including estimates by state Medicaid expansion status.

On Dec. 30, CMS released updated Medicaid and CHIP eligibility and enrollment data for the month of October 2015. According to the report, nearly 71.8 million individuals were enrolled in Medicaid and CHIP in October 2015 – an increase of 187,958 additional enrollees compared to the prior month (September 2015). Further, the report reflects an additional 13.5 million-enrolled individuals since October 2013 when initial Marketplace enrollment began.

2016

On a related note, on Jan. 25, 2016, the Congressional Budget Office (CBO) released its Budget and Economic Outlook: 2016-2026 (highlights; report). CBO notes that Medicaid spending grew by 16 percent ($36 billion), accounting for the largest increase, primarily because of newly eligible enrollees in states participating in ACA-authorized Medicaid expansion. CBO indicates that “average monthly enrollment of newly eligible Medicaid beneficiaries was 55 percent higher in 2015 than in the previous year – a total of 9.6 million compared with 6.1 million in 2014.”

On Jan. 27, CMS released updated Medicaid and CHIP eligibility and enrollment data for the month of November 2015. According to the report, nearly 71 million individuals were enrolled in Medicaid and CHIP in November 2015 – an increase of 274,893 additional enrollees as compared to the month prior (October 2015). Further, the report reflects an additional 14.1 million-enrolled individuals since October 2013 2013when initial Marketplace enrollment began.

On a related note, on Feb. 9, CMS released updated 2016 Federal Poverty Level (FPL) standardsapplicable to Medicaid and CHIP eligibility criteria.

On a related note, on Feb. 26, HHS released the 2015 Secretary’s Annual Report on the Quality of Care for Children in Medicaid and CHIP.

On Feb. 29, CMS released updated Medicaid and CHIP eligibility and enrollment data for the month of December 2015. According to the report, nearly 72 million individuals were enrolled in Medicaid and CHIP in December 2015 – an increase of 134,531 additional enrollees compared to the prior month (November 2015). Further, the report reflects an additional 14.5 million enrolled individuals since October 2013 when initial Marketplace enrollment began.

On a related note, on Apr. 8, CMS released a final rule that revises a rule released in November 2015 requiring states to submit plans to the federal government for monitoring Medicaid enrollees’ access to health care services (original rule here). Under the latest rule, states now have three more months to submit plans. The original July 1, 2016 deadline has been pushed back to Oct. 1, 2016.

On a related note, on Apr. 13, CMS released updated state-reported Medicaid and CHIP eligibility and enrollment data for the month of January 2016. According to the latest report, nearly 72.4 million individuals were enrolled in Medicaid and CHIP in Jan. 2016 – an increase of 121,958 additional enrollees since the prior month of December. Looking back to the initial Marketplace open enrollment period in October 2013, the report reflects an additional 14.9 million enrolled since that time – roughly a 26.5% increase over the average monthly enrollment during the July-September 2013 baseline period.

On a related note, on Apr. 28, CMS released a State Health Official (SHO) letter to facilitate successful re-entry for individuals transitioning from incarceration to their communities.

On Apr. 29, CMS released updated state-reported Medicaid and CHIP eligibility and enrollment data for February 2016. According to the latest report, an additional 79,413 people were enrolled in Medicaid or CHIP during the month of February, as compared to January data, amounting to over 72.4 million enrollees.

On May 4, CMS announced the release of the 2014 Medicaid Managed Care Enrollment Report (PDF). The annual report profiles enrollment statistics for Medicaid managed care programs as of July 1 of each year. According to the report, 77 percent of Medicaid’s 71.7 million enrollees were covered by any type of managed care plan in 2014. The broader statistic includes beneficiaries receiving comprehensive benefits as well as limited coverage. Approximately 60.5% of Medicaid beneficiaries are enrolled in comprehensive managed care.

On a related note, on May 25, CMS released updated state-reported Medicaid and CHIP eligibility and enrollment data from March 2016. According to the latest report, nearly 72.5 million individuals were enrolled in Medicaid and CHIP. Compared to February data, the report shows an additional 15,490 people were newly enrolled in March. Similar to February data, the report reflects an additional 15 million enrolled in Medicaid and CHIP since the initial Marketplace open enrollment period in Oct. 2013 – roughly a 26.6% increase over the average monthly enrollment during the July-Sept. 2013 baseline period.

On June 13, CMS issued an informational bulletin on Strategies to Enroll and Retain Eligible Children in Medicaid and CHIP. The bulletin discusses what CMS calls “highly effective existing tools” that are available to all states to support enrollment and retention of eligible children.

On June 22, CMS released an updated VIII Group Break Out report, containing three months of state-by-state enrollment data for VIII Group, the New Adult Group eligible for Medicaid in states that implemented the expansion. The report shows that of 58.2 million total Medicaid enrollees, nearly 6.1 million fell into the newly eligible VIII New Adult Group as of December 2015. Released concurrently, the Total Medicaid Assistance Expenditures VIII Group Break Out report shows that total computable expenditures for newly eligible VIII Group enrollees as of June 2015 was over $13 billion. Pursuant to Section 2001, the federal share of these costs was 100 percent. That rate will remain at 100 percent through 2016, then begin to slowly shift costs to the state in 2017.

On June 30, CMS released updated state-reported Medicaid and CHIP eligibility and enrollment data from March 2016. According to the latest report, nearly 72.4 million individuals were enrolled in Medicaid and CHIP. This represents a drop of 63,064 fewer people enrolled in April 2015 compared to March 2016. The report also reflects an additional 15 million enrolled in Medicaid and CHIP since the initial Marketplace open enrollment period in Oct. 2013 – roughly a 26.5 percent increase over the average monthly enrollment during the July-Sept. 2013 baseline period.

On July 28, CMS released updated state-reported Medicaid and CHIP eligibility and enrollment data from May 2016. According to the latest report, 72.5 million individuals are currently enrolled in Medicaid or CHIP, including 15 million additional individuals compared to October 2013 when initial Marketplace enrollment began. 151,705 additional persons enrolled in May 2016 compared to April 2016.

On Aug. 25, CMS released state-reported Medicaid and CHIP eligibility and enrollment data for June 2016. According to the report, an additional 144,441 people were enrolled in Medicaid or CHIP during the month of June, as compared to May, amounting to almost 72.7 million enrollees.

On Sept. 27, CMS released state-reported Medicaid and CHIP eligibility and enrollment data for July 2016. According to the latest report, an additional 134,541 people were enrolled in Medicaid or CHIP during the month of July, as compared to June data, amounting to more than 72.8 million total enrollees. Within the 48 states that reported child enrollment figures for the month of July, total Medicaid child and CHIP enrollment reached nearly 35.4 million.

On Oct. 3, CMS announced the award of $300,000 to the Greater Flint Health Coalition (GFHC) to help enroll Medicaid and CHIP-eligible children.

In December 2016, CMS released the December 2016 monthly report on Medicaid and CHIP eligibility and enrollment data. According to CMS, nearly 16.2 million additional individuals were enrolled in Medicaid and CHIP in December 2016 compared to the period prior to the start of the first Marketplace open enrollment period (July-September 2013), indicating over a 28 percent increase over the baseline period. Also in December 2016, CMS released an informational bulletin related to the 2017 Supplemental Security Income (SSI) and Spousal Impoverishment Standards.

2017

On a related note, in late March 2017, CMS issued an informational bulletin regarding the issuance of updated FPL guidelines. The 2017 FPL guidelines reflect a 1.3 percent increase in the Consumer Price Index for All Urban Consumers (CPI–U) between calendar years 2015 and 2016. The bulletin also contains the 2017 Dual Eligible Standards chart.

On a related note, on June 7, CMS issued an informational bulletin clarifying the required processes for completing redeterminations of eligibility when Medicaid adult group beneficiaries turn 65 or attain Medicare eligibility, highlighting opportunities for states to reduce administrative burdens and promote smooth transitions for these beneficiaries. The guidance specifically addresses the Medicaid expansion group.

June 27, CMS released updated, state-reported Medicaid and CHIP eligibility and enrollment data for the month of April 2017. Per the latest data, over 74.5 million individuals were enrolled in Medicaid and CHIP in the 51 states reporting April 2017 data – nearly 69 million in Medicaid and over 5.6 million enrolled in CHIP. This marks a 16.7 million (or a near-30 percent) increase in Medicaid and CHIP enrollment since the October 2013 baseline period for the 49 states that reported relevant data in both periods.

On Aug. 30, CMS released updated, state-reported Medicaid and CHIP eligibility and enrollment data for the month of June 2017. Per the latest data, 74.4 million individuals were enrolled in Medicaid and CHIP in the 51 states reporting June 2017 data – 68.6 million in Medicaid and over 5.8 million enrolled in CHIP. This marks a 16.6 million (or a 29 percent) increase in Medicaid and CHIP enrollment since the October 2013 baseline period for the 49 states that reported relevant data in both periods. As in the two months prior, nearly 36 million individuals were enrolled in CHIP or were children enrolled in the Medicaid program in the 48 states reporting child enrollment data for June 2017. This indicates that children enrolled in Medicaid and individuals enrolled in CHIP comprise more than 50.3 percent of the total Medicaid and CHIP program enrollment.

2018

In April, CMS posted updated, state-reported Medicaid and CHIP eligibility and enrollment data for the month of February 2018. According to the latest data, nearly 74 million individuals were enrolled in Medicaid and CHIP for the 51 states reporting data during the month of February 2018.

In June, Virginia Gov. Ralph Northam (D) signed a 2018-2020 biennial budget into law, directing the state to expand Medicaid to roughly 400,000 Virginians. Virginia marks the 33rd state (plus DC) to expand Medicaid pursuant to the ACA.