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Medicaid adviser says program enrollment declined by 1.9 million over 2 years

Total enrollment in Medicaid and the Children's Health Insurance Program declined by approximately 1.9 million people between May 2017 and May 2019, according to a congressional Medicaid adviser.

The Medicaid and CHIP Payment and Access Commission, or MACPAC, presented data Sept. 26 that showed enrollment in Medicaid and CHIP declined by almost 930,000 children and about 787,000 adults over the two-year period. MACPAC analyzed data from the Centers for Medicare and Medicaid Services, according to the presentation.

MACPAC advises Congress on policy and regulatory matters for Medicaid, the joint federal and state health insurance program that mainly covers people with low incomes, a wide population including children and the elderly. The commission delivers policy recommendations to Congress twice each year in March and June; it does not have legislative authority.

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CHIP is a program within Medicaid that provides health insurance to children whose families have income levels too high to qualify for the program and may not be able to afford private insurance.

Enrollment varied by state

The data showed that enrollment levels varied across the country. While 35 states and the District of Columbia saw enrollment decreases during the two-year period, 15 states saw Medicaid enrollment go up.

Missouri had had a decline in total Medicaid and CHIP enrollment of 12.6%, and a decline in child enrollment in the programs of 15.1%, both figures were the highest in the country. Wyoming's adult enrollment in Medicaid and CHIP declined by 17.7%, the largest decline over the period analyzed.

Martha Heberlein, a principal analyst for MACPAC, said several driving factors of the decline in enrollment were brought up when researchers spoke with states. Heberlein said that administrative processes changed by the Affordable Care Act could have contributed to the decline.

Policy changes like the effective removal of the ACA's individual mandate and the recent finalization of the public charge rule also may have contributed to the declines, according to Heberlein. The public charge rule is a new immigration policy that includes Medicaid enrollment as a determining factor for allowing individuals to legally enter the U.S. or change their residency status.

Peter Szilagyi, a MACPAC commissioner, said the data was "really disturbing."

MACPAC Commissioner Christopher Gorton said the commission should be concerned about the data and keep watching the trend. However, he stressed that there are a lot of complex factors that could contribute to a decrease in enrollment.

A recent report from Georgetown University's Center for Children and Families also showed a decline in child Medicaid enrollment. The report, released May 30, showed that child enrollment in Medicaid dropped by 828,129 in 2018, the largest year-over-year decline since at least 2000.

The U.S. Census Bureau's annual health insurance coverage report, released Sept. 10, also showed a decline in Medicaid and CHIP coverage for children. The report showed that the number of uninsured children in the U.S. increased by 425,000 in 2018. The increase was driven by a drop in coverage from public insurance programs like Medicaid and CHIP. While the number of children covered by private insurance remained relatively flat, public coverage dropped by 1.3 percentage points, according to the report.