Preliminary data for April 2022 show that total Medicaid/Children’s Health Insurance Program enrollment has grown by 23.9% since February 2020, an August 3 report by Kaiser Family Foundation shows. This represents an increase of 17 million people, reaching 88.3 million total people enrolled. 

KFF’s report analyzed the Centers for Medicare and Medicaid Services’ Performance Indicator Project Data. It comes after the Department of Health and Human Services’ announced that the national uninsured rate reached a record low of 8% in early 2022.

The increases in enrollment are likely because of changes in the economy, policy changes like Medicaid expansion in the Affordable Care Act and the temporary continuous enrollment requirement from the Family First Coronavirus Response Act, the report said. 

The continuous enrollment requirement prohibits states from disenrolling Medicaid enrollees during the pandemic emergency period. States in return receive a temporary increase in the federal Medicaid match rates. Continuous enrollment has paused “churning” in Medicaid, meaning when people temporarily lose coverage when they disenroll and then have to re-enroll.

All states saw a growth in total Medicaid/CHIP enrollment from 2020 to 2022. Oklahoma, which expanded Medicaid in July 2021, experienced the largest growth at 64.5% and Connecticut had the lowest at 14.8%. Utah, Idaho, Nebraska and Missouri also expanded Medicaid in the last two years.

Most of the increases in enrollment from 2020 to 2022 are from Medicaid, which rose by 25.9%, or 16.7 million enrollees. CHIP, meanwhile, has only increased by 5%, or 336,000 enrollees, and 15 states saw declines in enrollment. This is likely because of changes in family income, leading children to move from CHIP to Medicaid coverage, KFF found.

Adult enrollment has increased by 33.1% from 2020 to 2022, or 11.3 million adults. Child enrollment increased at a slower pace: 14.7%, or 5.2 million children.

After the ACA Medicaid expansion was implemented in 2014, there were major increases in Medicaid and CHIP enrollment. The trend reversed from 2017 to 2019, going from 73.4 million enrolled to 71.2 million, representing a 3% decrease. The decrease was due to a robust economy, but in some cases people who were eligible for coverage had challenges in the enrollment and renewal process, the report said.

It’s possible the trend could switch course again soon. Although there has been a continuous increase in Medicaid enrollment in the past two years, the increases seem to be slowing, KFF found. Additionally, when the public health emergency ends and continuous enrollment expires, many could lose coverage. Currently this is set for mid-October, but the Biden administration may extend it for another 90 days, the report said.

When the continuous enrollment requirement ends, states have up to 14 months to return to normal operations. During this period, states will disenroll people who no longer qualify for coverage. KFF estimates that between 5.3 million to 14.2 million could be disenrolled when this happens.

“How states manage the large volume of redeterminations during the ‘unwinding’ of the continuous enrollment requirement, as well as how states engage with enrollees and other stakeholders, will impact the continuity of coverage for millions of Medicaid enrollees,” the report said.

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