Cross-posted at ACA Signups
The January CMS Medicaid/CHIP Report has finally been released:
According to a new CMS report released today, between October and January, more than 8.9 million individuals were determined eligible for Medicaid or CHIP through state agencies and through state-based Marketplaces. More than 2 million people were informed in January that they are eligible for Medicaid and the Children’s Health Insurance Program (CHIP); more of those individuals are in states that have chosen to expand Medicaid coverage to more of their residents.
These numbers include both Medicaid and CHIP new eligibility determinations in states that expanded coverage; determinations made based on laws that predate the Affordable Care Act and for groups not affected by the health care law; and in some states, Medicaid renewals. These numbers do not include Medicaid eligibility determinations made through the Federally-Facilitated Marketplaces (HealthCare.gov). Today’s report is the fourth in a series of monthly reports on state Medicaid and CHIP data. We anticipate reporting on Medicaid and CHIP enrollment in future months.
The 8.9M total includes all 4 months (Oct, Nov, Dec and Jan); the January-only total is around 2.44 million enrollees.
Again, some crucial things to remember about what the 2.44 million figure does and doesn't include:
--It does include state-based exchange enrollments.
--it does NOT include federal exchange enrollments.
--it does include non-exchange state agencies (traditional enrollments)
--it does include expansion in states that went with it.
--it does include woodworkers in all states.
--it does include redeterminations (renewals)...but only in SOME states.
I've had a chance to go through the report, plug the January numbers into the Medicaid Spreadsheet, and then either eliminate, reduce or even increase the number (due to it being a count of households instead of individuals for that state), depending on the footnotes in the report.
As I've done with the prior reports, I've had to eliminate the CMS data from 11 states (+DC) entirely because those states insist on mixing in redeterminations (renewals) with the new enrollees. Since there's no way of separating them out, I've had to delete these completely. These include DC, IA, MA, MI, NV, ND, NM, SD, TX, UT, VA and WY.
A 13th state, Missouri, includes renewals for CHIP enrollments but doesn't include them for Medicaid (don't ask me why the do it for one but not the other), while a 14th state, Rhode Island, does the reverse--they included renewals for Medicaid but not for CHIP (!!!!!)
Between this and the othe reductions (mostly removing duplicated data which HHS already reported in their report), the actual starting number has dropped from 2.44 million down to 1.57 million. From there, it inches up a smidge due to 5 states (AK, CT, NV, NC and OR) counting households instead of people (although Nevada doesn't get counted at all, since they're one of the states which mixed in renewals).
Add all of these to the mix and the grand totals come out as follows, based on my revised model from earlier this week:
—Legal ACA Expansion ONLY: 3.65 Million (up from 3.27 Million)
—Expansion + Woodworkers: 4.91 Million (up from 4.29 Million)
MEANWHILE, on the Private QHP Side:
Using my new projection model, which accurately called both the announcement (a week or more earlier) of both the
"close to 4 million" announcement on 2/20 and
4 million even on 2/25, I'm confident enough to make my official call for the actual
February HHS Enrollment Report, which probably will be released on or around March 13, give or take:
—902,000 Total Exchange-Based Private QHP Enrollments between 2/02/14 - 3/01/14
—4,202,000 Total Exchange-Based Private QHP Enrollments between 10/1/13 - 3/01/14-
You'll notice that I'm being very careful about how I word this, for several reasons.
First of all, notice that the February dates start and end 1 day later (2/02 - 3/01 instead of 2/01 - 2/28). It's still 28 days, but shifted one day forward. The reason for this is the same reason why the projection model cuts off 20% of the January number, even after the daily average is adjusted: The HHS reports run through the end of the calendar week, not the calendar month. As a result, the "January" report actually included the last 3 days of December and the first day of February (12/29 - 2/01)...for 5 weeks total...while the February report will include only 4 weeks (2/02 - 3/01):
Next comes the "Paid vs. Unpaid" factor. Notice that only 1 state (Washington) specifies "paid only", even though there are 6 other states which have started reporting the breakdown between the two (Maryland just started doing so yesterday). Until yesterday I was carefully only including paid enrollments for all 7 states in the projection...but this morning I realized that the HHS report will probably include unpaid as well...for every state except for Washington.
Since for purposes of this prediction, I'm trying to guess what the HHS report itself will be, I went back and added the unpaid numbers back into the projection model, which raised the total estimate up by about 15,000 from my "final call" tweet last night (serves me right for including "final").
In other words, the number of paid enrollments will probably still be around 20-25% lower than the HHS total (around 3.3 million).
However, as I've repeatedly pointed out on several occasions, there's nothing either surprising or even concerning about this, because many of the unpaid enrollments are due to the premiums not being due yet, while others (including my own family's situation) are due to the insurance companies themselves having a screwed-up billing system which may take a month or two to sort itself out.
That said, there are still a number of people who haven't paid their premiums yet which can't be blamed on the insurance companies or the payment deadlines either, which I'm putting at around 10% or so.
So, if you want to be a real stickler about it, call it:
--4.20 million total Exchange-based QHPs
—3.78 million either Paid or Unpaid for Legitimate Reasons
—3.30 million Paid Only, No Excuses (even if it's not due yet, the insurance company lost your records, etc.)
Finally, notice that I'm specifically referring to EXCHANGE-BASED QHP enrollments only:
--I'm not including the (admittedly few) SHOP Small Business enrollments, which really should be included since they're part of the ACA exchanges.
--More importantly, I'm not including the large number (at least half a million, most likely 2-3 million or more) of off-exchange (direct) enrollments. Whether these should be included or not is a matter of perspective, but they certainly shouldn't be written off either.
So, there you have it: I'm saying that the HHS Report itself will state 900K in February, 4.2 million cumulative. We should know in about 2 weeks whether I'm full of beans or not.