Medicaid enrollment to decrease by 8.6% in 2024: KFF

Medicaid enrollment is projected to slide further next year, according to an annual budget survey of Medicaid officials conducted by KFF and Health Management Associates in collaboration with the National Association of Medicaid Directors (NAMD).

More than 10 million Medicaid enrollees have been disenrolled nationally as of Nov. 8, following the end of COVID-19 public health emergency (PHE) policy that stated Medicaid programs needed to keep members enrolled during the pandemic. Those requirements ended in May, leading to millions without Medicaid coverage. Often, beneficiaries’ coverage is terminated for procedural reasons or wrongfully canceled with little notice. A survey from The Harris Poll found that 35% of members said they were not contacted by their health plan to renew coverage.

State directors told KFF that they expect enrollment to decline (PDF) by 8.6% in fiscal year 2024, while Medicaid spending growth will decrease to 3.4%. The state share of Medicaid spending will increase by 17.2% once federal matching funds expire Dec. 31. Enrollment estimates account for churn, or individuals reenrolling in Medicaid that lost coverage due to Medicaid redeterminations, said Liz Williams, KFF senior policy analyst, during a webinar Tuesday.

“A lot of the findings from the Kaiser survey are very consistent with the experience in New York, both from the enrollment projections to the state Medicaid spending growth, and the challenges that lie ahead” said Amir Bassiri, deputy commissioner of the office of health insurance programs and New York state Medicaid director. “The unwind is still our number one priority … thus far we are seeing a decline in enrollment that is relatively consistent with what we projected.”

He added that the state’s share of Medicaid spending has increased 10% to 15%, driven by investment in primary care, hospital and nursing home and behavioral health reimbursements.

Utah Medicaid Director Jennifer Strohecker said the state’s Medicaid program has grown dramatically by 71% during the PHE due to the state’s high job growth, low unemployment and influx of worker migration.

“It's really made it incredibly challenging for us to forecast enrollment and spending projections for 2024,” she explained. “Our disenrollment has continued at an aggressive rate since unwinding started seven months ago. This was not expected.”

Fee-for-service provider rate increases will outpace rate restrictions in 2023 and 2024, with the largest increases for nursing facilities and home and community-based services providers, the report said. Rate increases will be the highest for nursing facilities. Sixteen states also reported FFS coverage for GLP-1 weight-loss medications like Ozempic and Wegovy.

Nearly two-thirds of states that contract with managed care plans reported implementing risk corridors, allowing states and health plans to share profits or losses if spending falls outside of thresholds.

The most frequently reported benefit category of benefit expansion is mental health and substance use disorder services, followed by pregnancy and postpartum services and telehealth. Telehealth expansion under state plans is expected to continue next year.

Also on Tuesday, the Centers for Medicare & Medicaid Services announced that Missouri extended its pregnancy coverage for postpartum individuals through Medicaid and the Children’s Health Insurance Program for 12 months, making it the 40th state to be approved for extended coverage. It is expected 18,000 people will be eligible for Medicaid a full year after pregnancy.

“I applaud Missouri’s decision to extend postpartum coverage for a full year after delivery,” said Department of Health and Human Services (HHS) Secretary Xavier Becerra. “Today’s announcement marks another important milestone in the effort to confront the nation’s maternal mortality and morbidity crisis. The Biden-Harris Administration continues to demonstrate its commitment to improve maternal health. HHS continues to support policies and programs that help ensure the health of mothers and babies. I urge all remaining states to extend postpartum coverage to do so.”

Strohecker anticipates her state’s Medicaid unwinding process will continue to plague the state in 2024. She also noted that Utah is not as “far along” on health equity initiatives being tackled in other states.

Bassiri agreed with her concerns, adding that all state Medicaid directors agree that workforce challenges is a huge concern.

“That is really something that keeps me up at night, because I know how hard everyone is working across the country, and particularly in New York, to fulfill some of the federal obligations … and that we retain as many people as possible that have been enrolled over the past three years,” said Bassiri.