Colorado’s Medicaid numbers aren’t surging as fast as predicted amid COVID-fueled joblessness, but the program’s administrators aren’t relaxing yet, since federal decisions and the economy’s unpredictable trajectory could still force them to come up with additional funding.
So far, the increase has been more modest, but it’s difficult to predict the trajectory only one month into the fiscal year, said Kim Bimestefer, HCPF’s executive director. The number of people enrolled in Medicaid in Colorado increased by about 100,000 from February to mid-August, topping 1.3 million.
There hasn’t been a large increase in people buying insurance through the marketplace, either. About 159,000 people had coverage through plans they bought on the marketplace as of the end of July, which is about 18,000 more than were enrolled at the same time in 2019, said Monica Caballeros, spokeswoman for Connect for Health Colorado.
Most of that growth came from the special enrollment period from late March through the end of April, she said. People who lose a job can buy coverage through the marketplace, but they have to do it within 60 days of losing their old health insurance.
HCPF has since revised its estimate to predict 427,000 people in Colorado could enroll in Medicaid by the end of next June. But, Bimestefer said, the department might need to raise that number again if a second virus surge causes more layoffs, parents have to drop out of the workforce to supervise at-home learning, or the federal government extends a policy of allowing more people to stay on Medicaid.
The department is working with the Office of State Budget Planning to project how much it might cost to cover newly eligible people under different scenarios, she said.
The federal Centers for Medicare and Medicaid Services declared a public health emergency in March, preventing states from removing anyone from Medicaid until Oct. 25. That means HCPF isn’t conducting the annual reviews to determine if a household isn’t eligible for coverage anymore because they increased their income or moved out-of-state, Bimestefer said. By October, they estimate about 200,000 people will be up for review, though most probably will still be eligible because incomes usually don’t increase during a recession, she said.
Medicaid, a joint federal and state program, is the largest source of health insurance in the United States, providing coverage — along with the Children’s Health Insurance Program — to more than 72.5 million Americans of limited means, according to the federal government.
Why are numbers lower than expected?
Colorado’s lower-than-expected enrollment numbers could reflect people dealing with more pressing issues first, said Adam Fox, director of strategic engagement at the Colorado Consumer Health Initiative.
“Many of them are focused on keeping a roof over their heads or keeping food on the table,” he said.
Some people also may expect they’ll be hired back or find a new job quickly, Bimesteffer said. If the job market remains difficult for a prolonged time, more of those people may decide to find out if they qualify for Medicaid, she said.
A survey of unemployed people conducted with the Colorado Department of Labor and Employment found about one-fifth of those who didn’t have insurance planned to apply for Medicaid, Bimesteffer said. About 46% said they planned to stay uninsured, which is especially concerning now, because people without insurance tend to delay care due to fear of the financial consequences, she said.
“That’s not OK during a pandemic,” she said.
It’s possible that people don’t realize they qualify for Medicaid, Fox said. The program calculates eligibility on a monthly basis, so people who previously earned too much might qualify if they haven’t been able to find another job, he said. A single adult who isn’t pregnant can earn up to $1,415 per month, and a family of four can make up to $2,904. Children and pregnant adults may be eligible for a different state-run program, even if their income is higher than those cutoffs.
Concerns about enrollment surge
If a surge in enrollment does come, the impact on hospital finances would be substantial, said Emily Johnson, director of policy analysis at the Colorado Health Institute. The difference between what Medicaid pays and what most commercial insurance plans pay for the same care would mean a substantially larger hit to hospital revenues than any of the payment changes posed in the legislature this year, she said
“That dwarfed the financial impact of those other proposals” in projections, she said.
The federal portion of the Medicaid budget increased from 50% to 56.5%, which has helped absorb some of the state’s costs, Johnson said. Still, they’ll likely have to put off rate increases for providers or new benefits like expanded addiction treatment if the number of members increases substantially, she said.
The impact on patients seeking care looks like it could be less severe, however, Johnson said. Providers they interviewed felt prepared to take on more patients covered by Medicaid, and were more concerned people would continue to put off non-emergency care, she said.
“Even the providers who aren’t super worried about the Medicaid surge are worried about the decrease in demand for services,” she said.