Medicaid enrollment increased by 5M during pandemic—but not for reasons you may think

A new study found that efforts by states to make it easier for beneficiaries to sign up for Medicaid didn't lead to a major boost in enrollment from March through September 2020. (Getty/designer491)

Medicaid enrollment swelled by approximately 5 million from March through September 2020, but the boost may not just be due to job losses stemming from the pandemic, a new study found.

The study, released Wednesday, found enrollment increases were roughly the same between Medicaid expansion and non-expansion states. The study also explored the impact of simplification steps for people to sign up for Medicaid.

The study found that from January 2019 to September 2020 Medicaid enrollment increased from 48.2 million to 51.8 million in Medicaid expansion states and 17.2 million to 18.8 million in non-expansion states.

Researchers also found that 5 million more people joined Medicaid from the onset of the pandemic in March 2020 through September.

The pandemic sparked massive job losses that led to concerns that Medicaid enrollment would swell.

“Unexpectedly, we found that enrollment growth was greater in states with smaller changes in unemployment in 2020,” the study, published in the Journal of the American Medical Association, said.

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The result could indicate that the Medicaid growth is “associated with factors other than job loss, including reduced work hours making more people eligible,” the study said.

Other reasons could be a greater focus on healthcare during the pandemic.

Researchers speculated that a new maintenance of effort requirement signed into law in March could play a role. The requirement gives states more federal funding if they agree to not disenroll anyone from Medicaid for the duration of the COVID-19 public health emergency, which is expected to go through 2021.

Several states also took steps to make it easier for people to sign up for Medicaid, including extending any presumptive eligibility to additional groups and “more lenient residency criteria for individuals temporarily residing out of state because of the pandemic,” the study said.

However, the findings did not show that these simplification steps led to a boost in Medicaid enrollment.

The largest changes in enrollment were in Idaho, which started expansion in January 2020, and Kentucky.

Job losses from the pandemic initially sparked concerns that it could affect the payer mix for providers, as government programs such as Medicaid pay less than employer-sponsored plans.

It remains unclear whether the job losses are sparking major shifts in the payer mix. An August 2020 analysis from the Advisory Board found that the payer mix has largely only experienced modest shifts. This is likely partly due to increased coverage of COBRA that helps laid off workers maintain their coverage or workers were furloughed rather than laid off.