Iowa in ‘uncharted territory’ as Medicaid numbers swell

MM Curator summary


Iowa’s enrollment in traditional Medicaid has surged 16% while enrollment by the expansion population has surged 30%.


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COVID pandemic fuels surge in sign-ups for health insurance program



A stethoscope sits on an examination table in an exam room. (Bloomberg News)

DES MOINES — Enrollment in Medicaid and Iowa’s related Health and Wellness insurance programs saw double-digit surges in Iowa due to the COVID-19 pandemic, according to data compiled by a state forecasting group.

Since the pandemic hit Iowa in March 2020, Iowa’s regular Medicaid program added 64,134 individuals through last month while an additional 51,669 individuals enrolled in the Health and Wellness program that offers slightly fewer benefits for recipients between the ages of 19 and 64 who are not pregnant and do not earn more than 133 percent of the federal poverty level.

That represented a 15.56 percent increase when comparing July’s 487,193 Medicaid enrollees to the 423,059 enrolled when the pandemic began, said Jess Benson, a senior Legislative Services Agency fiscal analyst who provides data for the state’s Medicaid Forecasting Group.

The increase in the Health and Wellness program was even steeper, jumping 30 percent, from 176,903 participants in March 2020 to 228,572 last month.

Last month’s Medicaid total included 280,905 children, 90,436 adults, 83,231 disabled Iowans and 32,621 elderly residents.

“We’ve never experienced anything like this before so this is kind of uncharted territory for all of us,” Benson said.

The influx of more than 115,000 new enrollees gradually built as Iowans lost their jobs – and their employer-based health insurance – as the pandemic took hold. State officials project Medicaid and the Health and Wellness program will continue to add 3,000 to 7,000 individuals per month through December. At that point, the eligibility parameters may change, lifting a current prohibition on “dis-enrolling” individuals while a federal public health emergency is in effect.

The suspension of program dis-enrollments is a condition for Iowa receiving a 6.2 percent matching fund rate in federal assistance as part of the COVID-19 relief package. That adjustment of nearly $135 million in fiscal 2020 and $275.4 million last fiscal year enabled Iowa’s Medicaid program to amass “huge carry-forward” balances, Benson noted. Those balances are projected at $244 million for fiscal 2021 and $228 million in the current fiscal year that began July 1.

The matching federal funds helped provide some relief to states struggling to afford the increasing pace of sign-ups for Medicaid, a program for low-income and disabled people.

Once the state is allowed to drop individuals who no longer need or qualify for Medicaid, Benson said he expects enrollment will gradually decline by 100,000 or more. He said reviews will take place to remove people who “normally would have fallen off,” but he was not certain the numbers would settle back to the previous levels around 425,000 Medicaid participants.

“It seems like whenever we go through one of these massive expansions, when we pull back we never get back to that level that we were at before,” he said.

Earlier this year, the federal Centers for Medicare and Medicaid Services released data indicating that nearly 9.9 million people enrolled in Medicaid and the Children’s Health Insurance Program between February 2020 and January 2021 because of the COVID-19 pandemic – a 13.9 percent increase nationally. Iowa’s increase at that time was in the 12 percent range.

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