FY 2024 Annual Performance Plan and Report - Strategic Goal 1: Objective 1.1

Fiscal Year 2024
Released March, 2023

Topics on this page: Objective 1.1 Increase choice, affordability, and enrollment in high-quality healthcare coverage | Objective 1.1 Table of Related Performance Measures

Objective 1.1: Increase choice, affordability, and enrollment in high-quality healthcare coverage

HHS supports strategies to increase choice, affordability, and enrollment in high-quality healthcare coverage.  HHS promotes available and affordable healthcare coverage to improve health outcomes in our communities and empowers consumers with high quality healthcare coverage choices.  The Department also leverages knowledge and partnerships to increase enrollment in health insurance coverage. 

The Office of the Secretary leads this objective.  The following divisions are responsible for implementing programs under this strategic objective: ACL, AHRQ, ASPE, CMS, HRSA and OASH.  In consultation with OMB, HHS has determined that performance toward this objective is progressing.  The narrative below provides a brief summary of progress made and achievements or challenges, as well as plans to improve or maintain performance.

Objective 1.1 Table of Related Performance Measures

The purpose of this measure is to increase enrollment in CHIP and Medicaid from 43,542,385 children in FY 2011 to 44,538,869 children by the end of FY 2024.  Our enrollment target for FY 2024 takes into consideration that the prior FY enrollment targets have not been met since FY 2017, and that the majority of eligible children are enrolled in Medicaid and CHIP.  Additionally, the FY 2024 Medicaid and CHIP enrollment target accounts for potential declines in Medicaid and CHIP child enrollment that may result from states resuming normal operations after the end of the continuous enrollment condition initially authorized in section 6008(b)(3) of the Families First Coronavirus Response Act (FFCRA), which required states to maintain enrollment for most individuals enrolled in Medicaid since March 2020, as a condition of receiving a 6.2 percentage point increase in the Federal Medical Assistance Percentage (FMAP).  For example, state renewal processing after the end of the continuous enrollment condition will impact individuals that have retained their coverage during the COVID-19 PHE in Medicaid because of the FFCRA continuous coverage requirement and in CHIP for states that elect the optional flexibilities to temporarily delay acting on changes in circumstances that would impact eligibility, and delay timely processing of renewals in CHIP.  These changes will lead to terminations of coverage for children that are determined to be ineligible for Medicaid or CHIP at renewal during the eligibility period after the continuous enrollment condition ends.  The FY 2024 enrollment target is set at the same enrollment projections for FY 2023.  We anticipate this to be a reasonable goal for FY 2024 given that states will continue to process renewals from the COVID-19 Public Health Emergency (PHE) at the start of FY 2024, which will result in terminations of enrollees that do not complete renewals or are otherwise no longer eligible for Medicaid and CHIP.  These terminations will likely be reflected in the FY 2024 results as a decline in Medicaid and CHIP enrollment.  After the continuous enrollment condition ends, there will be a great focus on retention of child enrollment in Medicaid and CHIP, however, we do not expect to see returns to pre-pandemic levels of Medicaid and CHIP child enrollment until FY 2025.  Additionally, a 2021 analysis by the Urban Institute reveals that 91.9% of eligible children were enrolled in Medicaid and CHIP in 2019.  The remaining 4 million, or 8.1% of uninsured children are the hardest to reach.

The data for this goal comes from state’s submission of required quarterly and annual child enrollment data, which include the number of children who are enrolled in Medicaid, separate CHIP programs, and Medicaid expansion CHIP programs.  The enrollment counts reflect an unduplicated number of children ever enrolled during each year and are not reflective of point-in-time enrollment.

Measurement and reporting on this measure align with the CMS Strategic Plan pillar to expand access to quality, affordable health coverage and care, and supports the CMCS Blueprint objectives of ensuring all youth have access to a full breadth of physical and behavioral health services, and maximizing coverage retention across CMS programs as the COVID-19 PHE unwinds. 

CMS’ strategy to increase the availability and accessibility of health insurance coverage for children includes collaborating with its State and Federal partners, continuing to implement statutory provisions that encourage program simplification, supporting CHIP outreach grantees, and bolstering its data collection activities.

CHIP, including the Connecting Kids to Coverage Outreach and Enrollment Program, is currently funded through FY 2029.  The HEALTHY KIDS Act, as included in P.L. 115-120, extended CHIP funding for six years through FY 2023, and the Advancing Chronic Care, Extenders and Social Services Act (referred to as the ACCESS Act and included in Pub. L. No. 115-123), provides CHIP funding for an additional four years, for FY 2024 through FY 2027.  The Consolidated Appropriations Act of 2023 further extends CHIP funding through FY 2029.  These laws also included provisions related to the extension and reduction of federal financial participation for CHIP, maintenance of effort for children’s Medicaid and CHIP coverage, and the extension of express lane eligibility.  The Connecting Kids to Coverage Outreach and Enrollment grants and National Campaign received $120 million in funding for outreach and enrollment activities through FY 2023, $48 million for FY 2024 to FY 2027, and $48 million for FY 2028 to FY 2029.

The Connecting Kids to Coverage grants and the National Campaign fund activities that are aimed at reducing the number of children who are eligible for Medicaid and CHIP but are not enrolled and improving retention of eligible children who are currently enrolled.  Most recently, on July 19, 2022, CMS awarded 36 new cooperative agreements, with awarded amounts ranging from $664,179 to $1,500,000.  These grants have a 3-year period of performance which began on July 19, 2022.  On October 17, 2022, CMS published a Notice of Funding Opportunity for an additional $6 million of HEALTHY KIDS Act funding that is available to enroll and retain American Indian/Alaska Native (AI/AN) children in Medicaid and CHIP. The award date for these cooperative agreements is scheduled for April 2023.  Eligible entities for this funding opportunity include Indian Health Service providers, Tribes and Tribal organizations operating a health program under a contract or compact with the Indian Health Service under the Indian Self Determination and Education Assistance Act, and Urban Indian organizations operating a health program under the Indian Health Care Improvement Act.

The Medical Expenditure Panel Survey (MEPS) collects data on the specific health services that Americans use, how frequently they use them, the cost of these services, and how they are paid for, as well as data on the cost, scope, and breadth of health insurance held by and available to U.S. workers. The Household Component (MEPS HC) Tables Compendia has recently been updated moving to a more user friendly and versatile format (https://meps.ahrq.gov/mepstrends/home/index.html).  Interactive tables are provided for the following: use, expenditures, and population; health insurance, accessibility, and quality of care; medical conditions and prescribed drugs.  The new format greatly expands the number of tables generated dependent on the parameters entered by the user.

The MEPS Tables Compendia is scheduled to be expanded by a minimum of 250 tables per year.  Tables can be used to produce nationally representative estimates of medical conditions, health status, use of medical care services, charges and payments, access to care, experience with care, health insurance coverage, income, employment and other important information. For the Insurance Component there are a total of 3,982 national level tables and 7,207 state and metro area tables.  Additionally, there are 1,296 tables available for the MEPS Household Component.  The total number of tables available to the user population is currently 12,485.

The MEPS Tables Compendia is a source of important data that is easily accessed by users.  Expanding the content and coverage of these tables furthers the utility of the data for conducting research and informing policy.  Currently data are available in tabular format for the years 1996 – 2021.  This represents over twenty years of data for both the Household and Insurance Components, enabling the user to follow trends on a variety of topics.

For more than 50 years, HRSA funded health centers have delivered affordable, accessible, quality, and cost-effective primary health care to patients regardless of their ability to pay.  During that time, health centers have become an essential primary care provider for millions of people across the country.  Health centers advance a model of coordinated, comprehensive, and patient-centered primary health care, integrating a wide range of medical, dental, behavioral health, and patient support/enabling services.  Today, approximately 1,400 health centers operate nearly 15,000 service delivery sites that provide care in every U.S. State, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and the Pacific Basin.  Historically, success in increasing the number of patients served by health centers has been due in large part to the development of new health centers, new satellite sites, and expanded capacity at existing clinics.  In 2021, health centers served 30.2 million patients, an increase of approximately 1.6 million patients from 2020, or 6 percent.

HRSA funded health centers deliver affordable, accessible, quality, and cost-effective primary health care to patients regardless of their ability to pay.  Health centers emphasize coordinated primary and preventive services that promote reductions in health disparities for low‐income individuals, racial and ethnic minorities, rural communities, and other underserved populations.  In FY 2021, approximately 90 percent of health center patients were individuals or families living at or below 200 percent of the Federal Poverty Guidelines, as compared to approximately 27.5 percent of the U.S. population as a whole.  HRSA set the FY 2024 target based on historical program trends of the composition of health center patients.

Endnotes

¹ Medicaid 36,850,065/CHIP 9,212,516

² Medicaid 37,152,321/CHIP 9,288,080

³ Medicaid 37,245,202/CHIP 9,311,300

⁴ Medicaid 37,338,314/CHIP 9,334,579

⁵ Medicaid 37,338,314/CHIP 9,334,579

⁶ Medicaid 35,720,173/CHIP 8,930,043

⁷ Medicaid 35,391,786/CHIP 9,147,083

⁸ Medicaid 35,391,786/CHIP 9,147,083

⁹ Medicaid 36,862,057/CHIP 9,460,160

¹⁰ Medicaid 36,287,063/CHIP 9,632,367

¹¹ Medicaid 35,090,387/CHIP 9,654,742

¹² Medicaid 35,055,383/CHIP 9,043,038