Medicaid and CHIP Eligibility Determinations Rise in December

Posted January 22, 2014

Medicaid and the Children’s Health Insurance Program (CHIP) eligibility determinations grew throughout the end of 2013, especially in states that have chosen to expand coverage to more of their residents, according to a new CMS report released today.

According to the report, between October and December over 6.3 million individuals were determined eligible to enroll in Medicaid or CHIP through state agencies and through state-based Marketplaces. That includes 2.3 million people in December alone, an increase of over 20 percent from November. These numbers include both Medicaid and CHIP new eligibility determinations in states that expanded coverage, determinations made on prior law, and in some states, Medicaid renewals and groups not affected by the health care law. These numbers do not include Medicaid eligibility determinations made through the Federally-facilitated Marketplaces (HealthCare.gov).

Because of the Affordable Care Act, many consumers can enroll in new affordable private health insurance options in the Health Insurance Marketplace, and many others are now eligible for their state’s Medicaid or CHIP programs.

These gains are made possible by collaboration between CMS and the states that operate these programs on the ground. 

For example, some states have been taking advantage of flexible, innovative ways to get people enrolled. One option adopted in states like Arkansas and Oregon is to reach out to people who qualify for the Supplemental Nutrition Assistance Program (SNAP), because they are also likely to be eligible for Medicaid.

The Affordable Care Act provides states with new opportunities to expand their Medicaid programs to meet the needs of more uninsured residents. In states that expand coverage, most individuals with incomes up to 133 percent of the Federal Poverty Level, or $15,282 for an individual and $31,322 for a family of four, will be eligible for Medicaid coverage that begins January 1, 2014. December determinations were 73 percent higher in states that chose to expand Medicaid compared to -1 percent in states that rejected the expansion.

Not only is expanding Medicaid coverage helping many people gain health coverage, it’s a good deal for states: Coverage for newly eligible adult beneficiaries is fully federally paid for under the Affordable Care Act for the first three years, and never less than 90 percent for the years following.

The increase in the number of Medicaid determinations across the country is encouraging, but more work is left to do to ensure that the millions of uninsured Americans eligible for these program gain coverage. Today’s report is the third in a series of monthly reports on state Medicaid and CHIP data. The data were reported to CMS from state Medicaid and CHIP agencies as part of the new Medicaid and CHIP Performance Indicator process initiated under the Affordable Care Act and supplements data on Marketplace activity released by HHS.

Read today's report.

Read the November report.

Read the October report.