New data show Medicaid and CHIP enrollment decreasing as continuous coverage requirement in Medicaid ends
The Medicaid and CHIP Payment and Access Commission (MACPAC) today released the 2023 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 2023, 91.5 million people were enrolled in Medicaid and CHIP. While enrollment is higher than in the same period the prior year, it has been decreasing from its peak following the end of the continuous coverage requirement that was attached to the federal medical assistance percentage (FMAP) increase under the Families First Coronavirus Response Act (FFCRA, P.L. 116-127).
MACStats presents the most current data available on Medicaid and CHIP, two programs that provide a safety net for low-income populations who otherwise would not have access to health care coverage and that cover services other payers often do not. The data book provides context for understanding these programs and how they fit in the larger health care system.
“As we begin to assess and draw lessons from the public health emergency and Medicaid unwinding about ways to strengthen Medicaid and CHIP, this publication provides timely insights for anyone who wants to understand how these programs affect the lives of almost 30 percent of the U.S. population,” said MACPAC Chair Melanie Bella.
Total Medicaid spending was $830.6 billion in fiscal year (FY) 2022 (Exhibit 16), while spending for CHIP was $22.3 billion (Exhibit 33). Medicaid spending increased 10.2 percent in FY 2022. This increase was largely driven by increased enrollment under the continuous coverage requirement during the public health emergency as spending per full-year equivalent enrollee only increased 1.0 percent (Exhibit 10). In FY 2021, individuals eligible on the basis of disability and enrollees age 65 and older accounted for about 21 percent of Medicaid enrollees but about 52 percent of program spending (Exhibits 14 and 21). Many of these individuals were users of long-term services and supports.
MACStats continues to include tables on access to and experience of care among non-institutionalized individuals. As in prior years, Medicaid and CHIP enrollees of all ages were more likely to be persons of color and to report fair or poor health than individuals 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).
More highlights from this year’s edition of MACStats include:
- Almost 39 percent of U.S. children had Medicaid or CHIP coverage in 2022 (Exhibit 2).
- About 34 percent of individuals enrolled in Medicaid or CHIP in 2022 had family incomes below 100 percent of the federal poverty level (Exhibit 2).
- Medicaid and CHIP together accounted for 17.8 percent of national health expenditures in calendar year 2021, less than either Medicare (21.2 percent) or private insurance (28.5 percent) (Exhibit 3).
- Over half of Medicaid spending for enrollees was for capitation payments to managed care plans (Exhibits 17 and 18).
- Drug rebates reduced gross drug spending by over half (52.9 percent) in FY 2022 (Exhibit 28). About two-thirds (64.1 percent) of Medicaid gross spending for drugs occurred under managed care in FY 2022.
Visit this link for the PDF and spreadsheet versions of the December 2023 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 the State Children’s Health Insurance Program (CHIP). For more information, please visit: www.macpac.gov.