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Medicaid Enrollment Trends in the COVID Quarters

 

March 3, 2021

With the impact of Medicaid Expansion coupled with a lackluster economy, Medicaid and Children's Health Insurance Program (CHIP) membership grew rapidly from 2014 until peaking at 75 million members in January 2017.  Medicaid and CHIP membership began to retreat in 2017 due to improving economic conditions, dropping to 71 million by the end of 2019.  The COVID-19 pandemic severely impacted the economy in 2020, swiftly reversing the enrollment declines experienced between 2017 and 2019.  After three quarters of the COVID impact, the Centers for Medicare & Medicaid Services (CMS) Monthly Medicaid & CHIP Application, Eligibility Determination, and Enrollment Reports & Data reported over 77 million Medicaid and CHIP members in their preliminary September 2020 enrollment data.  This report provides a brief overview of the enrollment trends during the first three quarters of 2020; a period of time significantly impacted by the economic downturn caused by the COVID-19 Pandemic.

Medicaid and CHIP Enrollment
State  4Q19 3Q20 Growth %
 CA 11,588,323  12,148,521  4.8% 
 NY 5,997,950  6,475,604  8.0% 
 TX 4,180,368  4,626,433  10.7% 
 FL 3,613,005  4,006,720  10.9% 
 PA 2,938,411  3,158,811  7.5% 
 IL 2,812,371  3,086,700  9.8% 
 OH 2,609,614  2,881,716  10.4% 
 MI 2,320,304  2,535,419  9.3% 
 GA 1,816,358  2,004,162  10.3% 
 NC 1,772,156  1,919,854  8.3% 
 AZ 1,708,073  1,903,428  11.4% 
 All Others 29,781,380  32,559,346  9.3% 
 Total  71,138,313  77,306,714  8.7% 
Source: CMS Monthly Medicaid Enrollment Reports. 

The COVID-19 Impact

By the end of 2019, Medicaid and CHIP enrollment was at its lowest point since the beginning of 2017.  In the first nine months of 2020, enrollment surged 8.7% to a new record of 77.3 million members.  While California faired better than many states, others such as Texas, Florida, and Arizona experienced greater than average growth in Medicaid and CHIP Enrollment.

FFS vs. MCO

State Medicaid programs generally fall into two main categories:  Fee for Service (FFS) which represents traditional Medicaid coverage that is administered by the State government and Managed Care, where states partner with Managed Care Organizations (MCOs) and related entities to administer Medicaid services.  In 2020, there were 11 states that follow the traditional FFS model.  However, many states manage a portion of their Medicaid population under a traditional FFS arrangement.  Mark Farrah Associates aggregates Medicaid data from multiple state and national sources, in its Health Coverage Portal™ database, to build a complete picture of the Medicaid segment.  The table below compares the mix of Medicaid membership between “FFS and Other", which includes FFS membership and a small amount of uncategorized membership, with the MCO membership over the past four quarters.  Since the onset of COVID-19, MCO membership, in terms of overall mix, has increased from 78.5% to 80.8% of the total Medicaid population, while FFS dropped to 19.2% from 21.5% in 4Q19.

Medicaid Fee for Service Vs. Managed Care Mix
  4Q19 1Q20 2Q20 3Q20
 FFS & Other 21.5%  22.6%  20.7%  19.2% 
 MCO 78.5%  77.4%  79.3%  80.8% 
Source: Mark Farrah Associates' Health Coverage Portal/Statutory Insurance filings.   FFS & Other includes state managed Medicaid membership (FFS) and accounts for a small amount of uncategorized MCO membership.

Managed Care Market Share

At the end of September 2020, total managed Medicaid membership reported through statutory financial statements, and other relevant state reports, was approximately 61.2 million according to Mark Farrah Associates' latest Medicaid enrollment statistics from the Health Coverage Portal™.  This represents a growth of over 6.5 million members, or 12% as compared to 4Q19.  As referenced in the chart below, all of the leading companies in the segment reported membership growth.  Anthem, Molina, and Independence Blue Cross (IBX) all reported membership gains, exceeding the segment average of 12%. Conversely, Centene and UnitedHealth reported membership growth below the segment average. Overall, the top five companies have maintained a strong market presence during 2020, ending with 45.7% of the total Medicaid managed care market. Membership among the top five companies experienced an overall increase of 3 million (12%).

Market Share Membership Growth for Leading MCOs
Company  4Q19 Market Share 3Q20 Market Share Growth %
 Centene* 10,027,819  18.3%  10,915,893  17.8%  8.9% 
 Anthem* 5,804,282  10.6%  6,631,830  10.8%  14.3% 
 UnitedHealth  4,739,641  8.7%  5,227,459  8.5%  10.3% 
 Molina 2,813,780  5.1%  3,418,201  5.6%  21.5% 
 IBX 1,599,680  2.9%  1,806,285  3.0%  12.9% 
 All Others 29,683,758  54.3%  33,219,868  54.3%  11.9% 
 Total 54,668,960  100%  61,219,536  100%  12% 
Source: Mark Farrah Associates' Health Coverage Portal/Statutory Insurance filings. * 4Q19 - adjusted to include membership  from the acquisition of WellCare (completed in January 2020).

Summary

Medicaid has provided health coverage for millions of low income Americans for decades.  Tough economic times caused by the current pandemic magnifies the importance of this safety net for millions of Americans.  Furthermore, the pandemic has shown how important it is for states and their MCO partners to be able to provide healthcare coverage for millions of additional members in a relatively short window of time.  While we do not know how long the current economic impact of COVID-19 will last, it is clear that the Medicaid segment will remain one of the most important for the health insurance industry and the country.  Mark Farrah Associates will continue to simplify the analysis of the health insurance industry through its line of innovative data portals.  Please stay tuned for future reports on the Medicaid segment.

About Mark Farrah Associates (MFA)

Mark Farrah Associates (MFA) is a leading data aggregator and publisher providing health plan market data and analysis tools for the healthcare industry. Our product portfolio includes Health Coverage Portal™, County Health Coverage™, Medicare Business Online™, Medicare Benefits Analyzer™, 5500 Employer Health PLUS, and Health Plans USA™. For more information about these products, refer to the informational videos and brochures available under the Our Products section of the website or call 724-338-4100.

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