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“After declines in enrollment from 2017 through 2019, preliminary data for December 2022 show that total Medicaid/CHIP enrollment grew to 92.3 million, an increase of 21.2 million from enrollment in February 2020 (29.8%), right before the pandemic and when enrollment began to steadily increase (Figure 1).¹ Increases in enrollment may reflect changes in the economy, changes in policy (like recent adoption of the Medicaid expansion in the Affordable Care Act), and the temporary continuous enrollment provision created by the Families First Coronavirus Response Act (FFCRA). Under the continuous enrollment provision, states generally cannot disenroll Medicaid enrollees while the provision is still in effect and in exchange, states receive a temporary increase in the federal Medicaid match rate. The continuous enrollment provision has halted churning in Medicaid – the temporary loss of coverage in which enrollees disenroll and then re-enroll within a short period of time – in addition to preventing Medicaid coverage loss during the pandemic. As part of the Consolidated Appropriations Act, signed into law in December 2022, Congress set an end to the continuous enrollment provision on March 31, 2023, and will phase down the enhanced federal Medicaid matching funds through December 2023. States that accept the enhanced federal funding can resume disenrollments beginning in April 2023 but must meet certain reporting and other requirements during the unwinding process. KFF estimates that Medicaid/CHIP enrollment will reach roughly 95 million enrollees in March 2023 before states may resume disenrollments during the “unwinding” of the continuous enrollment provision.”

Source: Corallo B, Moreno S. Analysis of recent national trends in Medicaid and CHIP enrollment [Internet]. San Francisco (CA): Henry J. Kaiser Family Foundation; April 4, 2023, accessed July 7, 2023.

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“Across the four states and four specialties in this study, more than a third of the physicians listed in provider network directories for Medicaid managed care plans treated ten or fewer Medicaid beneficiaries in a year. The share of these low-volume physicians varied little across states, suggesting a widespread mismatch between the physicians listed in provider network directories and those actively seeing Medicaid managed care beneficiaries. Among the set of contracted physicians who saw Medicaid beneficiaries, care was highly concentrated: The top quartile of primary care physicians, cardiologists, and psychiatrists were responsible for 86.2 percent, 69.2 percent, and 86.5 percent of claims, respectively. Taken together, our findings suggest that provider network directories may overstate the availability of physicians in the Medicaid program; many states’ reliance on directories to ensure network adequacy may be insufficient to ensure satisfactory access to physicians who are both valued by Medicaid managed care beneficiaries and willing to treat them.”

Source: Avital B. Ludomirsky, William L. Schpero, Jacob Wallace, Anthony Lollo, Susannah Bernheim, Joseph S. Ross, and Chima D. Ndumele. In Medicaid Managed Care Networks, Care Is Highly Concentrated Among A Small Percentage Of Physicians. Health Affairs 2022 41:5, 760-768.

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“Medicaid is a joint federal-state program that finances the delivery of primary and acute medical services, as well as long-term services and supports, to a diverse low-income population, including children, pregnant women, adults, individuals with disabilities, and people aged 65 and older. The State Children’s Health Insurance Program (CHIP) is a means-tested program that provides health coverage to targeted low-income children and pregnant women in families that have annual income above Medicaid eligibility levels but have no health insurance.

“An estimated 69 million individuals (21.1% of the U.S. population) received Medicaid or CHIP in 2021, and the programs accounted for $756 billion (18.7% of overall HCE [Health Consumption Expenditures]). This spending is about 11 percentage points higher than Medicaid/CHIP’s percentage of total HCE in 1970 (Figure 2). Furthermore, relative to other coverage, Medicaid spends the highest percentage of its expenditures on long-term services and supports, which include (1) other health, residential, and personal care; (2) nursing care facilities and continuing care retirement communities; and (3) home health care (Figure 1).”

Source: Congressional Research Service. In Focus: U.S. Health Care Coverage and Spending. Updated Feb. 6, 2023, last accessed July 7, 2023.

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“Title XIX of the Social Security Act is a Federal/State entitlement program that pays for medical assistance for certain individuals and families with low incomes and resources. This program, known as Medicaid, became law in 1965 as a cooperative venture jointly funded by the Federal and State governments (including the District of Columbia and the Territories) to assist States in furnishing medical assistance to eligible needy persons. Medicaid is the largest source of funding for medical and health-related services for America’s low-income population.

“Within broad national guidelines established by Federal statutes, regulations, and policies, each State establishes its own eligibility standards; determines the type, amount, duration, and scope of services; sets the rate of payment for services; and administers its own program. Medicaid policies for eligibility, services, and payment are complex and vary considerably, even among States of similar size or geographic proximity. Thus, a person who is eligible for Medicaid in one State may not be eligible in another State, and the services provided by one State may differ considerably in amount, duration, or scope from services provided in a similar or neighboring State. In addition, State legislatures may change Medicaid eligibility, services, and/or reimbursement at any time.

“Title XXI of the Social Security Act, the Children’s Health Insurance Program (CHIP, known from its inception until March 2009 as the State Children’s Health Insurance Program or SCHIP), is a program initiated by the Balanced Budget Act of 1997 (BBA; Public Law 105-33). The BBA provided $40 billion in Federal funding through fiscal year (FY) 2007 to be used to provide health care coverage for low-income children—generally those in families with income below 200 percent of the Federal poverty level (FPL)—who do not qualify for Medicaid and would otherwise be uninsured. CHIP funding was extended through FY 2027 by subsequent legislation, including the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA; Public Law 111-3); the Patient Protection and Affordable Care Act (Public Law 111-148) as amended by the Health Care and Education Reconciliation Act of 2010 (Public Law 111-152)—collectively referred to as the Affordable Care Act; the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA; Public Law 114-10); the Federal Register Printing Savings Act of 2017 (Public Law 115-120); and the Bipartisan Budget Act of 2018 (Public Law 115-123). Under CHIP, States may elect to provide coverage to qualifying children by expanding their Medicaid programs or through a State program separate from Medicaid. A number of States have also been granted waivers to cover parents of children enrolled in CHIP.”

Source: Brief Summaries of Medicare & Medicaid, Title XVIII and Title XIX of The Social Security Act as of October 15, 2018. Prepared by Barbara S. Klees, Eric T. Eckstein II, and Catherine A. Curtis, Office of the Actuary Centers for Medicare & Medicaid Services, Department of Health and Human Services, December 2018.

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World Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and sixteen other nations.

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Page last updated July 7, 2023 by Doug McVay, Editor.