Enrollment in Medicaid rises in Florida, nation

dchang@MiamiHerald.comApril 5, 2014 

Enrollment in Medicaid rose by about 245,000 people in Florida from October through February, reflecting a national trend as people who were previously eligible but not enrolled signed up for the state-federal health program for low-income Americans, federal officials reported Friday.

The increase, which officials linked to the health insurance enrollment process for the Affordable Care Act, comes despite the Florida Legislature's refusal to expand Medicaid.

Health and Human Services Secretary Kathleen Sebelius called the increase in Medicaid enrollments "encouraging" in a statement announcing the report. "But more work is left to do," she wrote, "to ensure that the millions of uninsured Americans eligible for these programs gain coverage."

Nationwide, Medicaid enrollment in February increased by about 5 percent, or an additional 3 million people, over a pre-ACA average for the three-month period ending in September 2013, according to a report from the Centers for Medicare and Medicaid Services or CMS. About 62.3 million Americans are enrolled in the program.

However, the Medicaid data reported Friday includes discrepancies in the way states and the federal government count program enrollments and applications.

For instance, some states included renewals in their Medicaid application counts, and others counted only new applicants. Some states also included in their counts any

one with dual coverage from Medicaid and Medicare, the federal health program for the elderly and disabled, while other states excluded those beneficiaries.

Florida's Medicaid enrollment numbers do not include dual-eligible beneficiaries, and the state's reported 281,000 new applications received in February did not include renewals.

And there's another difference in the way Florida and the federal government tally the numbers. Florida's pre-ACA enrollment average of 2.9 million does not count those signed up for the Children's Health Insurance Program or CHIP -- but the increased numbers reported by the federal government for October through February do include CHIP enrollments.

CHIP covers children in families whose incomes are too high to qualify for Medicaid but who can't afford private coverage.

Still, overall Medicaid enrollment appears to be on the rise.

The greatest enrollment increases occurred in the 26 states that expanded Medicaid eligibility under the health law.

Increases were recorded in most of the 24 states that have refused to expand the program, including Florida, which recorded an 8.2 percent increase -- the greatest rise in Medicaid enrollment rates among those states that have resisted expansion.

About 3.2 million Floridians were enrolled in Medicaid and CHIP through February, CMS reported. According to independent studies by nonprofit groups such as Kaiser Family Foundation and Urban Institute, Medicaid expansion would cover an estimated 764,000 to 886,000 additional low-income Floridians.

The health law expanded Medicaid to include all Americans with incomes under 138 percent of the federal poverty level, or about $15,800 a year for an individual. But a U.S. Supreme Court ruling in June 2012 said expanding Medicaid was optional for states.

States that expanded Medicaid reported an average 8 percent increase in enrollment, while states that refused to expand the program saw an average increase of 1.6 percent, according to the CMS report.

CMS officials said the enrollment numbers underestimate the growth because not all states reported Medicaid enrollment. The totals do not include sign-ups for March, when exchanges experienced an enrollment surge.

While enrollment closed on March 31 for private plans under the ACA, there is no deadline for people to apply for Medicaid.

Federal officials also have repeatedly stated that there is no deadline for states to expand Medicaid.

"We're going to keep working with the remaining states as they decide to come on board," Sebelius said Friday.

Those who are eligible for Medicaid don't always know it. In January, Kaiser reported that the majority of uninsured Floridians who are eligible for Medicaid -- but not yet enrolled in coverage -- are children.

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