Table 1A shows the distribution of Medicaid enrollment for each month of 1999 by the 23 eligibility groups used in CMS reporting. This is the first time national Medicaid enrollment data have been reported on a monthly basis. Before 1999, CMS was only able to report the number of people ever enrolled in Medicaid at some point during the year. However, the 1999 MSIS allows CMS to compile monthly enrollment information for Medicaid, both at the national and state levels, in addition to the annual data.
Monthly information greatly expands the analytic power of CMS Medicaid data. Enrollment patterns can now be tracked at a precise level. Exactly when changes in enrollment occur can now be pinpointed, as well as the groups that are affected. Monthly data also make it easier to compare CMS Medicaid data to existing state level data, since most state-generated Medicaid reports and statistics use monthly or average monthly data. Finally, the monthly enrollment data can be used in combination with the annual "ever enrolled" data to calculate a lower bound estimate of turnover in each state's Medicaid enrollment (this analysis follows in Table 2). Although not undertaken for this study, analysts can also use monthly MSIS data to track individual enrollment patterns over time.
In addition to the national level data in Table 1A, Table 1B shows monthly Medicaid enrollment during the first and last month of 1999 for each state, with separate columns for aged, disabled, child and adult enrollees. Table 1B shows which individual states experienced growth in monthly Medicaid enrollment during the year. However, these data should not be used without consulting the state specific footnotes, since the month-to-month enrollment data in some states have problems.
Table 1A shows that, during 1999, Medicaid enrollment nationwide grew from 32.2 million in January to 34 million in December. This represents an increase of 1.8 million in monthly enrollment during the year, or 6 percent growth. However, over half of the growth during the year is attributable to an expansion of coverage to about one million women in California (eligibility group 55) at year end. Persons in this expansion group qualified only for limited Medicaid benefits related to family planning under an 1115 waiver extension.
Including the California expansion, adult enrollment increased over 19 percent during 1999. Parental enrollment in 1999 would have been up about 1.5 percent without the expansion in California. Child enrollment increased by 550,000 during the year, for a growth rate of about 3.4 percent. Disabled enrollment grew about 2.4 percent during the year. Growth in aged enrollment was negligible, at 0.3 percent.
During the year, monthly enrollment averaged about 32.7 million (data in the last column). On average, half of Medicaid enrollees, or 16.4 million, were children. About 6.6 million were disabled individuals, 6 million were parents or other caretaker relatives and pregnant women (all reported under the adult grouping), and 3.6 million were aged. On average during the year, about 44 percent of individuals qualified for Medicaid because they either received SSI benefits or qualified under the AFDC rules in effect in before the 1996 federal welfare reform legislation.
According to Table 1B, 37 states and the District of Columbia reported increases in monthly Medicaid enrollment from January to December during 1999. The following nine states had growth in monthly enrollment during 1999 exceeding 10 percent: Alaska (32.7 percent), California (21.5 percent), Maryland (21.4 percent), Oklahoma (19.6 percent), Vermont (17.9 percent), Missouri (17.3 percent), Rhode Island (15.1 percent), Indiana (13.3 percent), and Wisconsin (12.2 percent). Modest declines were reported in monthly enrollment levels by year end for 13 states, including Georgia, Hawaii, Iowa, Michigan, Nevada, New Jersey, New York, Ohio, Oregon, Texas, Utah, Virginia and West Virginia.
For aged enrollees, Vermont showed the greatest percent growth in monthly enrollment, with almost a 16 percent increase by year end. This resulted in part from Vermont's special 1115 program extending pharmacy benefits to dual eligibles (who were not otherwise eligible for Medicaid benefits except for Medicare cost-sharing expenses).
For disabled enrollees, Utah showed the greatest percent growth in monthly Medicaid enrollment, with an increase of almost 10 percent by year end. Although Maryland and South Carolina appear to report large increases in disabled enrollment, footnotes to Table 1B indicate that the year end levels of disabled enrollment in these states are misleading since they largely reflect reporting anomalies.
For child enrollees, Alaska and Oklahoma showed the greatest percent growth in monthly enrollment, with 50 and 34 percent more children, respectively, enrolled in December than were enrolled in January. This resulted in part from enrollment growth in the State Children Health Insurance Program (SCHIP) that extended Medicaid coverage to additional children in each state.
For adult enrollees, several states had extraordinary growth in monthly enrollment during 1999: California (an increase of 96 percent from January to December 1999), Missouri (87 percent), Wisconsin (57 percent), Rhode Island (31 percent), and Vermont (30 percent). In all of these states except Rhode Island, the growth stemmed from 1115 demonstrations. As noted above, the California 1115 demonstration provided adults with only family planning services, not full Medicaid benefits. The Rhode Island growth in adult enrollment resulted from its expanded 1931 rules related to AFDC coverage.
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