New data show increase in Medicaid and CHIP enrollment of 8.9 percent since July 2020, driven by COVID-19 pandemic and continuous coverage requirements
The Medicaid and CHIP Payment and Access Commission (MACPAC) today released the 2021 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 2020 to May 2021, enrollment in Medicaid and CHIP increased by about 8.9 percent, driven in large part by the economic downturn created by the COVID-19 pandemic as well as federal requirements that states not disenroll individuals during the COVID-19 public health emergency (Exhibit 11).
Medicaid and CHIP covered more than one quarter of the U.S. population in 2019, with 83 million enrolled in Medicaid and 9.7 million enrolled in CHIP at some point during the year (Exhibit 1). Enrollment increased in all states and the District of Columbia. The growth in enrollment ranged from 5.8 percent in the District of Columbia to 24.1 percent in Nebraska (Exhibit 11).
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 fiscal year (FY) 2020, the share of federal spending on Medicaid, CHIP, and Medicare fell from the previous fiscal year as spending in other areas of the federal budget increased, due to the availability of COVID-19 pandemic-related relief such as unemployment compensation, coronavirus tax relief and economic impact payments, and other housing credits (Exhibit 4).
Total Medicaid spending was $688.0 billion in FY 2020 (Exhibit 16). Spending for CHIP was $19.8 billion (Exhibit 33). The annual growth in Medicaid spending increased from 1.8 percent in FY 2019 to 8.9 percent in FY 2020. The spending growth reflects increased enrollment and federal requirements that states not disenroll individuals during the COVID-19 public health emergency (Exhibit 10). In FY 2019, individuals eligible on the basis of disability and enrollees age 65 and older accounted for about 22 percent of Medicaid enrollees but about 57 percent of program spending (Exhibits 14 and 21). Many of these individuals were users of long-term services and supports.
Children whose primary coverage source is Medicaid or CHIP are less likely to be in excellent or very good health than those who have private coverage (Exhibit 39), but are as likely to report seeing a doctor or having a well-child checkup 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 with private coverage (Exhibit 42).
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 second edition of MACStats to use data from the Transformed Medicaid Statistical Information System, which captures more recent data and information than previously available under the Medicaid Statistical Information System.
“As we begin to understand the effect of the COVID-19 pandemic and its implications for Medicaid and CHIP, this publication remains a vital resource for federal and state policymakers, researchers, and anyone who wants to know how Medicaid and CHIP affect the lives of more than one-quarter of the U.S. population who are covered by the programs,” 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 2019 had family incomes below 100 percent of the federal poverty level (Exhibit 2).
- As in prior years, 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 24 percent of enrollees and 18 percent of spending in FY 2019 (Exhibits 14 and 21).
- Drug rebates reduced gross drug spending by over half in FY 2020 (Exhibit 28), with 64.9 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 2021 MACStats: Medicaid and CHIP Data Book. Visit macpac.gov for MACPAC’s newest issue briefs: An Updated Look at Rates of Churn and Continuous Coverage in Medicaid and CHIP and The Effect of State Approaches to Medicaid Financing on Federal Medicaid Spending. 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.
