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Medicaid Eligibility Determinations from State Agencies Up in December

By Rebecca Adams, CQ HealthBeat Associate Editor

January 22, 2014 -- Almost 2.3 million people were determined eligible for Medicaid or the Children's Health Insurance Program (CHIP) in December, in addition to the 1.7 million people in November. The report does not say how many of these people were eligible under Medicaid rules that go back years and how many benefit from new rules under the health care law expanding eligibility to more adults.

The data are from state agency data, some of which is incomplete. The report does not include any enrollments from applications submitted through, the federal website handling enrollment in 36 states. Most of the hundreds of thousands of potentially Medicaid-eligible people who applied through have not yet had their applications transferred to the states, so those people have not yet received their benefit cards unless they reapplied through their state agencies.

When you count the total number of people who have qualified so far for Medicaid or CHIP from October to December, the number from state agencies is 6.3 million. That doesn't mean that 6.3 million people suddenly became eligible for Medicaid because of the health care law (PL 111-148, PL 111-152). Some of those people are just renewing their coverage, or were previously eligible for benefits but hadn't applied before.

The number of applications sent in to states in December was 3,187,202 forms (representing one or more people), up from 2,119,870 in November. During the three months before open enrollment started on Oct. 1, the average number of applications was 2,272,962.

But those numbers are based on partial numbers from the states, with some states not reporting new applications and others not reporting their three-month averages from July to September.

Reporting numbers in Medicaid is difficult because states have collected the data in different ways. Some include people who are renewing coverage while others break it out. A few count the number of people who applied instead of the number of applications filed.

Sometimes states count determinations by the number of households who qualify for the program instead of the number of individuals who are eligible. In many states, the data are unofficial or incomplete.

"It's important to note that these numbers are a preliminary window into the changes in Medicaid enrollment late last year," said National Association of Medicaid Directors Executive Director Matt Salo in an email. "States and CMS are still sorting out Medicaid enrollment from people who applied directly to the FFM (federal marketplace). And what many people don't read far enough to learn is that this number also can include people in some states who are eligible under pre-expansion (woodwork effect), and whose Medicaid enrollment was simply renewed."

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