Enrollment in Arizona's Medicaid program hits record 2M adults and children

Arizona's Medicaid program hit a record-high enrollment of 2 million people this month, and some experts predict the numbers will continue to rise.

The latest numbers show 27% — about 1 of every 4 state residents — is covered by the government health insurance program for low-income people.

Provisions in a federal coronavirus law that prevent Arizona from disenrolling people from the program may be contributing to the increase. Yet given the job loss and economic distress that the COVID-19 pandemic has caused, some experts predict more growth in Medicaid enrollment in the coming weeks and months.

There's no recent national data on whether Medicaid enrollment has spiked nationally since the World Health Organization declared COVID-19 a pandemic in March. That month, the U.S. Medicaid program enrolled 71 million people, or 1 in every 5 Americans. 

Enrollment data for the months after March has not yet been released, but recently released national studies have predicted  increases in Medicaid enrollment in the U.S. because of fallout from the pandemic.

Medicaid enrollment in Arizona has grown by nearly 140,000 people since March, Arizona data shows. Total enrollment in Arizona's $14 billion Medicaid program, which is called the Arizona Health Care Cost Containment system, was 2.01 million people as of July 1.

Federal coronavirus law: AZ can't disenroll people from AHCCCS

One factor that state officials say is playing a role in the total enrollment number is the federal Families First First Coronavirus Response Act, which prevents the state from removing people from the Medicaid rolls with only a few exceptions — for death,  moving out of state or voluntary withdrawal from the program, AHCCCS spokeswoman Heidi Capriotti wrote in an email.

"Two million enrolled members is the highest Medicaid enrollment in the program's history. That increase is not due to new applications as much as you might think," she wrote. "The typical enrollment churn is not occurring during the public health emergency."

Normally, Arizonans must renew with AHCCCS on an annual basis to make sure they are still meeting eligibility requirements. Regular AHCCCS income limits are $28,896 or less per year for a family of three.

The new federal law prevents states, including Arizona, that accept increased federal Medicaid matching dollars during the pandemic from disenrolling anyone who was enrolled as of March 18, 2020, or anyone who newly enrolls until after the national public health emergency declaration has been lifted.

While the national emergency is set to expire July 25, it is expected to be extended, which will prolong the freeze on disenrollment at least until the end of the calendar year, said Joan Alker, executive director of the Georgetown University Center for Children and Families.

"The declaration of public health emergency as a practical matter is going to be a post-election issue," Alker said. "The Congressional Budget Office is assuming for their baseline that the public health emergency is in place all through calendar 2021. Unfortunately, this virus isn't going away any time soon."

The freeze on disenrollment is a positive for families because now is not the time to be losing one's health coverage, Alker said. Normally, people go on and off Medicaid as their incomes fluctuate.

"Very few folks who are low-wage workers are seeing their income rise much right now and certainly not rise dramatically," she said. "It's avoiding a lot of red tape and administrative churn that is not productive at the best of times. I think the disenrollment freeze is very important."

Future spike in AHCCCS enrollment likely

While the immediate effect on enrollment numbers was potentially linked to the freeze on disenrollment, economic conditions are expected to cause continued increases.

In past recessions, Medicaid enrollment increases have lagged behind unemployment, which would mean a further spike in Medicaid numbers is on the way, Alker said. It's a matter of people knowing about their options and having the bandwidth to get enrolled, she said.

"I think we can expect these numbers to be going up in the next six months," Alker said.

"What we've heard from some of our state partners around the country is that families have really been focused on trying to get their unemployment insurance and their SNAP (food stamp) benefits if needed. They are prioritizing that and haven't got to the question of Medicaid yet."

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Given the state of the economy, a lot more people will likely be enrolling in Medicaid coverage as they lose their jobs and employer-based coverage, said Robin Rudowitz, co-director for the Kaiser Family Foundations program on Medicaid and the Uninsured.

"We did some analysis a few months ago that looked at people losing their job-based coverage and their jobs and it suggested a large majority of people in that group would become eligible for Medicaid," she said.

"We know that from previous economic downturns that Medicaid is a counter-cyclical program, so during downturns when people lose their jobs and their incomes, more people enroll in the program."

April data on Medicaid enrollment across the U.S. is expected to be released later this month, Rudowitz said.

"Looking down a month or two as we track what is happening with the economy, there's definitely anticipation that the economic effects will result in increased Medicaid enrollment."

'No national effort' to let families know their options

Allen Gjersvig, director of outreach and enrollment for the Arizona Alliance for Community Health Centers, said he's been surprised in recent months that more Arizonans have not been applying for AHCCCS and is concerned that families may not realize their options.

"I am concerned that families may not be aware of the availability of public coverage, particularly for their children," Georgetown University's Alker said. "If you have families that are newly unemployed or have lost income, there's been no national effort to let families know that public coverage options may be available."

While there are time restrictions and deadlines on some forms of insurance, there is not for AHCCCS and KidsCare — families and individuals may enroll in those programs year-round. Applications may be submitted online.

Arizonans who have recently lost their health insurance may contact a statewide network of health insurance assisters who will provide help for free. Go to www.coveraz.org/Connector  or call 800-377-3536 for bilingual help.

People who are unemployed who are uninsured and people who have recently lost health insurance coverage have options in addition to AHCCCS, Gjersvig said.

• Some people who may have lost employer-sponsored insurance will be eligible for COBRA (Consolidated Omnibus Budget Reconciliation Act, which is insurance for people after the loss of a job). However, COBRA is very expensive because consumers pay both their portion and the employer's share of the monthly premium.
• People who have lost coverage within the past 60 days are eligible for a Special Enrollment Period in the Health Insurance Marketplace (healthcare.gov). Many people who have lost coverage and income will now be eligible for significant financial assistance that can make coverage affordable. In most cases, coverage from Healthcare.gov will be less costly than COBRA.

More health coverage equals better health outcomes

Arizonans may have differing perceptions on the fact that 27% of our population is on AHCCCS, said Swapna Reddy, a clinical assistant professor at Arizona State University's College of Health Solutions.

Decades of data shows people on Medicaid have better health outcomes than people who have no health insurance.

"It really depends on how people see Medicaid. It's one of our major safety nets; some people think it is our biggest safety net in this country," Reddy said.

"And yet, we have not as a country come to kind of consensus of what we think about Medicaid. Medicaid and Medicare were passed in the same act in the 1960s by LBJ, yet Medicare is something that as a nation we for the larger part feel passionate about protecting. Medicaid, people have different opinions on."

Some of those perceptions have to do with who is on Medicaid. It's primarily children, people with disabilities, economically disadvantaged senior citizens and low-income, working families.

AHCCCS in Arizona was founded in 1982. Shifting public policies over the years have caused the enrollment numbers to shrink and expand. In 1985, AHCCCS enrolled 144,450 people.

Most recently, Arizona's Medicaid expansion in 2013 restored childless adults to AHCCCS and also increased income limits, which resulted in a larger AHCCCS population.

"If more people are gaining health insurance coverage, it's a good thing, especially in a pandemic when you need health insurance, when you need coverage when you need health care," Reddy said.

"I think it's really important to see the value of a safety net like Medicaid because I think what we need to be honest with ourselves about is that we are experiencing record joblessness rates, and what we know is that a majority of this country receives their health insurance through their employer."

Reddy said Arizona's Medicaid enrollment has typically been higher than the national level of enrollment. While this is the first time the numbers have reached 2 million, it's not the first time that one-quarter of the state's population has been enrolled, she said. 

After Medicaid expansion, AHCCCS enrollment began increasing and has often comprised 25% or more of the population. Before that, it was typically at about 20%.

Enrollment has been at least at 25% throughout 2020, with the numbers steadily increasing since April.

Going without health insurance is a bad option, experts say, because it could result in catastrophic medical bills for families. And if they can't pay those bills, the health system must absorb the cost. It's always cheaper when people are insured versus uninsured.

If COBRA or Affordable Care Act marketplace plans are not options, the remaining option is Medicaid, which in Arizona is a well-run, cost-efficient program, Reddy said.

"It's been sort of an unsung hero for a long time in this country and this state," Reddy said.

Reach health reporter Stephanie Innes at Stephanie.Innes@gannett.com or at 602-444-8369. Follow her on Twitter @stephanieinnes

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