New data show increase in Medicaid and CHIP enrollment of 7.2 percent since July 2022, but enrollment growth slows from prior year
The Medicaid and CHIP Payment and Access Commission (MACPAC) today released the 2022 edition of the MACStats: Medicaid and CHIP Data Book, with updated data on national and state Medicaid and State Children’s Health Insurance Program (CHIP) enrollment, spending, benefits, and beneficiaries’ health, service use, and access to care. As of July 2022, almost 90 million people were enrolled in Medicaid or CHIP.
From July 2021 to July 2022, enrollment in Medicaid and CHIP increased by 7.2 percent, following a 10.4 percent increase in Medicaid and CHIP enrollment from July 2020 to July 2021 (Exhibit 11). While enrollment in the programs has increased since 2020 due in large part to the federal requirements that states maintain eligibility during the COVID-19 public health emergency, the growth rate has slowed. Medicaid and CHIP covered almost 30 percent of the U.S. population in 2021, with 87.8 million enrolled in Medicaid and 8.6 million in CHIP (Exhibit 1). Enrollment increased in all states and the District of Columbia from July 2021 to July 2022. The growth in enrollment ranged from 1.8 percent in Connecticut to 20.7 percent in Oklahoma, where Medicaid expansion took effect in July 2021 (Exhibit 11).
As in prior years, Medicaid and CHIP enrollees of all ages were more likely to be persons of color and to report being in fair or poor health than people who were covered by private insurance (Exhibit 2). Children whose primary coverage source is Medicaid or CHIP are as likely to report seeing a doctor or having a wellness visit within the past year as those with private coverage, and more likely than those who are uninsured (Exhibit 40). While most children whose primary coverage source is Medicaid or CHIP had a usual source of care, they were less likely to have one compared with children who have private coverage (Exhibits 42 and 43). In fiscal year (FY) 2020, individuals eligible on the basis of disability and enrollees age 65 and older accounted for about 21 percent of Medicaid enrollees but about 56 percent of program spending (Exhibits 14 and 21). Many of these individuals were users of long-term services and supports and accounted for almost one-third of all Medicaid spending (Exhibit 20).
Although the share of the federal budget devoted to Medicaid and Medicare has grown steadily since the programs were enacted in 1965, Medicaid and CHIP spending combined continue to account for a small share of the federal budget. In FY 2021, Medicaid was a smaller share of the federal budget (7.6 percent) than Medicare (10.1 percent), for example. Both Medicaid’s and Medicare’s share of the federal budget are lower than in prior years because of a large increase in other mandatory program spending for relief related to the COVID-19 pandemic (Exhibit 4). Medicaid spending as a share of state budgets varies depending on whether federal funds are included.
Total Medicaid spending was $752.8 billion in FY 2021 (Exhibit 16). Spending for CHIP was $21.2 billion (Exhibit 33). The federal share was 69.5 percent of total Medicaid benefit spending in FY 2021, compared with an average federal share of 63 to 64 percent since 2015, due to an increase in the federal medical assistance percentage under the Families First Coronavirus Response Act that was retroactively applied to January 2020.
MACStats, published annually in December and updated regularly on macpac.gov, brings together the range of Medicaid and CHIP statistics—including eligibility and enrollment, benefits, service use, and access to care, and state and federal spending—that are often difficult to find across multiple sources.
“This publication provides invaluable insights for federal and state policymakers, researchers, health care stakeholders, and anyone who wants to know how Medicaid and CHIP impact the lives of almost 30 percent of the U.S. population who are covered by the programs,” said MACPAC Chair Melanie Bella. “This edition contains new survey tables and additional data that offer richer insights into Medicaid beneficiaries and their access to and experience with care that can highlight opportunities to advance health equity.”
More highlights from this year’s edition of MACStats include:
- Medicaid spending increased 9.6 percent in FY 2021, reflecting increased enrollment during the COVID-19 public health emergency. However, spending increased less than enrollment, leading to a 4.4 percent decrease in spending per full-year equivalent enrollee (Exhibit 10).
- Over 35 percent of individuals enrolled in Medicaid or CHIP in 2021 had family incomes below 100 percent of the federal poverty level (Exhibit 2).
- About 38 percent of U.S. children had Medicaid or CHIP coverage in 2021 (Exhibit 2).
- The new adult group, which includes individuals who are newly eligible for Medicaid under the Patient Protection and Affordable Care Act (ACA) and some adults who were previously eligible in states that expanded Medicaid prior to the ACA, accounted for 24 percent of enrollees and 19 percent of spending in FY 2020 (Exhibits 14 and 21).
- Drug rebates reduced gross drug spending by over half in FY 2021 (Exhibit 28), with 66.7 percent of Medicaid gross spending for drugs occurring under managed care (Exhibit 26).
Visit this link for the PDF and spreadsheet versions of the December 2022 MACStats: Medicaid and CHIP Data Book.
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ABOUT MACPAC
The Medicaid and CHIP Payment and Access Commission is a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on a wide array of issues affecting Medicaid and CHIP. For more information, please visit macpac.gov.