New data show increase in Medicaid and CHIP enrollment of 5.6 percent since July 2019, reflecting COVID-19 pandemic, economic downturn
The Medicaid and CHIP Payment and Access Commission (MACPAC) today released the 2020 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. From July 2019 to July 2020, enrollment in Medicaid and CHIP increased by about 5.6 percent, driven in large part by the economic downturn created by the COVID-19 pandemic.
Enrollment increased in all states except the District of Columbia and Montana. States where enrollment grew ranged from 0.2 percent in South Carolina to 30.2 percent in Idaho, which adopted the expansion of Medicaid to the new adult group in 2020 (Exhibit 11).
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 is the first edition of MACStats to use data from the Transformed Medicaid Statistical Information System (T-MSIS), which captures more recent data and information than previously available under the Medicaid Statistical Information System (MSIS). All states are now submitting T-MSIS data, which improves the timeliness, reliability, and completeness of data on Medicaid and CHIP.
Even with the increase in enrollment, Medicaid and CHIP combined still account for a smaller share of total health care spending than Medicare or private insurance. Medicaid accounted for a smaller share of the federal budget (9.2 percent) than Medicare (14.5 percent) in fiscal year (FY) 2019 (Exhibit 4).
Medicaid and CHIP together accounted for 16.9 percent of national health expenditures in calendar year 2018, less than either Medicare (20.6 percent) or private insurance (34.1 percent) (Exhibit 3). Medicaid and CHIP expenditures as a share of national health expenditures are projected to grow from 16.8 percent in 2019 to about 16.9 percent in 2028 (Exhibit 12).
“The COVID-19 pandemic and related unemployment have major implications for Medicaid and CHIP. This publication provides invaluable insights at a critical time for federal and state policymakers, researchers, and anyone who wants to fully understand what’s happening with the health care of the more than one-quarter of the U.S. population who are covered by Medicaid or CHIP,” said MACPAC Chair Melanie Bella.
More highlights from this year’s edition of MACStats include:
- Over 40 percent of individuals enrolled in Medicaid or CHIP in 2018 had family incomes below 100 percent of the federal poverty level (Exhibit 2).
- Medicaid and CHIP enrollees of all ages were more likely to be in fair or poor health than individuals who were covered by private insurance or who were uninsured (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 more than 20 percent of enrollees and 17 percent of spending in FY 2018 (Exhibits 14 and 21).
- About half of Medicaid spending for enrollees was for capitation payments to managed care plans (Exhibits 17 and 18). Spending for enrollees who are eligible for Medicaid on the basis of disability and enrollees who are age 65 and older has been shifting to managed care. In FY 2018, more than half of enrollees who are eligible on the basis of disability and over one third of enrollees age 65 and older were enrolled in comprehensive managed care, including in plans that provided managed long-term services and supports (Exhibit 30).
- Drug rebates reduced gross drug spending by over half in FY 2019 (Exhibit 28), with 63.3 percent of Medicaid gross spending for drugs occurring under managed care (Exhibit 26).
The 2020 edition includes reprints of eight exhibits from the 2019 data book on topics such as beneficiary characteristics, health service use, and access to care. These exhibits have not been updated from last year’s publication due to a delay in the release of data from the National Health Interview Survey.
Visit this link for the PDF and spreadsheet versions of the December 2020 MACStats: Medicaid and CHIP Data Book. Visit macpac.gov for MACPAC’s newest issue briefs on State Compliance with Electronic Asset Verification Requirements and State Management of Home- and Community-Based Services Waiver Waiting Lists. Follow us on Twitter @macpacgov.
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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.
