By Rebecca Adams, CQ HealthBeat Associate Editor
April 4, 2014 -- Enrollment in Medicaid and the Children's Health Insurance Program (CHIP) rose by more than 3 million people from the average enrollment level before Oct. 1 to Feb. 28, according to a report recently released by the Centers for Medicare and Medicaid Services (CMS).
The enrollment in February was 5 percent higher than for the period from July to September 2013, CMS said.
More than 62 million people were enrolled in Medicaid and CHIP in the 48 states that provided preliminary data for February. Data for three states—Connecticut, North Dakota, and Maine—were not included.
Samaia M. Hernandez, press secretary for Connecticut Gov. Dannel P. Malloy, said that 20,138 people enrolled in Medicaid or CHIP in Connecticut in February. That brought the state's total enrollment to 670,932. Numbers were not immediately available for North Dakota or Maine.
The Congressional Budget Office projected in its revised estimates that 8 million would enroll in Medicaid and CHIP in the first year after changes in the health care law took effect. Medicaid and CHIP enrollment occurs year-round and is not limited to special sign-up periods.
Enrollment in states that adopted the Medicaid coverage expansion increased five times more than states that opted not expanding to Medicaid under the law (PL 111-148, PL 111-152).
"The increase in Medicaid enrollments across the country is encouraging, but more work is left to do to ensure that the millions of uninsured Americans eligible for these programs gain coverage," said Health and Human Services Secretary (HHS) Kathleen Sebelius in a blog post. She said that federal officials expect enrollment in March to be even higher.
The states with the largest reported gains in enrollment were Oregon, West Virginia, and Vermont. Some of the states that reported a reduction in enrollment were Nebraska, Illinois, Alabama and Alaska.
Medicaid enrollment typically fluctuates throughout the year. But the increase is encouraging to advocates because the economy has improved. Medicaid and CHIP enrollment typically declines as economic conditions rise because some beneficiaries get jobs that offer health insurance or increase their income above the Medicaid eligibility threshold.
"Given that the economy has been improving and the trend should've been for enrollment to be leveling off, the bump has to reflect some of the increased activity" due to states' work in streamlining eligibility processes and the publicity about the health care law, said Kaiser Family Foundation Executive Vice President Diane Rowland, who also chairs the Medicaid and CHIP Payment and Access Commission.
Because enrollment levels bucked the expected trend, health policy analysts say that presumably the health care law is helping many more people get coverage.
"If the economy had plummeted, it'd be very hard to tease out what the increase is due to —whether it's due to economic forces or due to the promotion of eligibility," said Rowland.
The report showed that the 2.2 million people who were determined to be eligible for Medicaid or CHIP in February was almost 789,000 more than the number eligible in October.
The numbers for determinations represent all of the people who have applied through state agencies, including marketplaces in states that are operating their own health insurance exchanges.
The figures for determinations do not include people who have applied through healthcare.gov, the federal website handling enrollment in 36 states. However, some of the Medicaid-eligible people who tried to sign up on healthcare.gov reapplied through state agencies because the federal marketplace was unable to quickly transfer many of the applications for people who qualified for Medicaid to state officials.
The numbers reported by CMS officials are preliminary and may increase as all of the states provide data.
The total also may rise since some people also may have received coverage that retroactively took effect in February. States are working through a backlog of applications.
"The three million number is only likely to go up," said Joan Alker, the executive director of the Georgetown University Health Policy Institute Center for Children and Families.
Lots of questions about Medicaid enrollment remain. The report does not break out how many people became eligible under an expansion of Medicaid in states that broadened eligibility to people with income of up to 138 percent of the federal poverty line.
Federal officials also do not know how many people who enrolled were previously uninsured. And in many cases, the data also included renewals of people who were previously enrolled.
"We have to be patient to figure out the impact of the Affordable Care Act, both with respect to how Medicaid and CHIP enrollment has gone for currently eligible people and the newly eligible, and what impact this has on the uninsured rate," said Alker. "We really cannot answer those questions yet."
But since states traditionally have not publicly provided enrollment data on a monthly basis, the reporting by states will give policymakers a better sense of what is happening with enrollment once the information is more complete.
Alker said it is "terrific that CMS is getting this data in more real time than we ever had before but it's a work in progress."
Rowland called the report "commendable."
"It's a good start," she said. "It's not totally complete but it begins to give us a picture. But there's still a lot more digging that needs to go on."