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Medicaid Applications Drop in November, Administration Touts Marketplace Enrollment Growth

By Rebecca Adams, CQ HealthBeat Associate Editor

December 20, 2013 -- The number of applications from people trying to sign up for Medicaid and the Children's Health Insurance Program (CHIP) fell by almost 30 percent from October to November, according to recent estimates released by the Obama administration. The Obama administration sought to downplay the Medicaid estimates and highlight the recent enrollment growth in the private plans offered through the new marketplaces.

President Barack Obama addressed the issue of enrollment in a wide-ranging press conference last week.

"For all the challenges we've had and all the challenges that we've been working on diligently in dealing with both the ACA [health care law] and the website these past couple months, more than 500,000 Americans have enrolled through in the first three weeks of December alone," said Obama in the news conference. "In California, for example, a state operating its own marketplace, more than 15,000 Americans are enrolling every single day. And in the federal website, tens of thousands are enrolling every single day. Since October 1st, more than 1 million Americans have selected new health insurance plans through the federal and state marketplaces."

Obama said, "All told, millions of Americans—despite the problems with the website—are now poised to be covered by quality affordable health insurance come New Year's Day."

Congressional Republicans quickly noted that even with increased enrollment in the marketplace, the administration is far short of its own projections. The Ways and Means Committee said that the administration is 1.9 million people short of internal White House goals.

"These are not just arbitrary numbers," said a Ways and Means GOP statement. "Not meeting these targets will have repercussions—Americans whose plans were cancelled may not be able to enroll (and will face a gap in health care coverage) and premiums will skyrocket."

Estimated Medicaid Enrollments Decline

The number of people who applied and were determined to be eligible for the programs fell by about 20 percent from October to November, according to the report by the administration. In October almost 2.2 million people were determined to qualify for Medicaid or CHIP, while more than 1.7 million were considered eligible in November.

The estimates reflect a surge of 2,472,933 applications in October that apparently slid in November, when 1,736,809 applications came from people who tried to sign up through state agencies.

Enrollments were down in November even when compared to figures before the publicity around the health care law's open-enrollment period started. The number of applications fell by more than 10 percent from a three-month average from July through September.

The data are preliminary and incomplete, and they could change. The state of Pennsylvania, for instance, didn't report any data from November.

Indeed, federal officials significantly revised the October estimates upward from numbers they released last month. The Department of Health and Human Services adjusted the number of determinations in October from less than 1.5 million in Medicaid alone when reported last month to 2.1 million in the October estimates released last week.

Some states also used different criteria for counting people, another reason why the report can only be considered an estimate.

One health policy expert cautioned that the November data might be so preliminary that it might not be accurate.

"You might expect that once they finalize the data in November, you could see a similar rate as in October," said Sara Collins, vice president for the Health Care Coverage and Access Program at The Commonwealth Fund.

But though the specific numbers could change, there are several reasons why it is possible that more people tried to sign up in October than in November.

Momentum may have faded because some people who were easy to identify as Medicaid candidates sent in applications in October. In May, the Centers for Medicare and Medicaid Services (CMS) had encouraged states to reach out to people that they believe would be entitled to Medicaid based on their eligibility for other programs designed to help low-income individuals. Those groups included people who qualify for food stamps and parents of Medicaid-eligible children.

A handful of states took CMS officials up on that offer and made it easy for people who get other benefits for the poor to enroll. Some of the states that used targeted outreach early on—Arkansas, Illinois, Oregon and West Virginia—have seen a burst of Medicaid applications since open enrollment began on Oct. 1.

The people who are eligible but remain unenrolled may be harder to find.

And the holiday week of Thanksgiving also could have interfered with enrollments in November.

The 12-page enrollment report said the month-to-month drop could be due "to both the preliminary nature of the November data as compared to the finalized October numbers, as well as the low number of business days in November."

Another factor may be that some people who applied in October were individuals who actually were already enrolled in the program, according to some state officials. They may have heard about open enrollment and believed that they needed to reapply.

The Congressional Budget Office has estimated that about 9 million more people would enroll in Medicaid in the first year of implementation of the health care law (PL 111-148, PL 111-152).

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