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Avalere Analysis: Ten States Driving New Medicaid Enrollment

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700K to 1.3M Additional Medicaid Enrollees through March, If Current Trends Continue.

According to a new Avalere analysis, 10 states accounted for more than 80 percent of the 3 million new Medicaid enrollees under the Affordable Care Act (ACA) as reported by the Centers for Medicare and Medicaid Services (CMS). From October through February, California, Florida, Oregon, and Washington enrolled the most new participants. While Florida numbers drive a substantial portion of the 3 million new enrollees, figures from the summer 2013 time frame do not include Children’s Health Insurance Program (CHIP) enrollment. As a result, these figures are expected to be overstated.

“We continue to see dramatic variations across the states in terms of enrollment into new coverage programs,” said Jenna Stento, senior manager at Avalere Health. “While some differences may be a result of state decisions to expand Medicaid, certain non-expansion states are also seeing large increases in Medicaid enrollment.”

The Congressional Budget Office estimates that the ACA will result in 8 million new Medicaid enrollees in 2014. To date, CMS has reported 3 million new enrollees through February 2014. If March enrollment increases at the rate of Medicaid sign-ups observed between January and February, total enrollment could reach 3.7 million by the end of March.

However, March and April figures could bring more dramatic increases if outreach and enrollment efforts targeting the end of exchange open enrollment translate into new Medicaid enrollees. Specifically, if Medicaid sign-ups follow a similar pattern as exchanges, new Medicaid enrollees could reach 4.3 million by the end of March. In addition, recent figures released by CMS do not account for individuals assessed eligible for Medicaid through who have yet to be determined eligible by states.

“In March, enrollment in exchange plans surged dramatically as individuals signed up for coverage at more than twice the February rate of enrollment,” said Dan Mendelson, Avalere Health CEO. “Medicaid enrollment could increase at a similar rate in March, and April could see another bump as individuals assessed eligible for Medicaid by the federal exchange undergo determination by state Medicaid agencies.”

There is no open enrollment period for the Medicaid program; therefore, enrollment will continue year round.


: For this analysis, Avalere Health utilized data from CMS Medicaid and the Children’s Health Insurance Program (CHIP) enrollment reports and the Assistant Secretary for Planning and Evaluation (ASPE) exchange enrollment reports. We compared the monthly enrollment reported in February to the monthly enrollment reported from the July-September 2013 time period. To estimate the number of potential new Medicaid and CHIP enrollees in March 2014, we used two rates: 1) lower bound rate, based on growth in Medicaid enrollment January to February 2014; and 2) upper bound rate, based on growth of exchange enrollment from February 2014 to March 2014. Exchange enrollment growth is based on 7.1M estimate announced by President Obama on April 1. Official enrollment estimates have not yet been published and are subject to change.

Sources: CMS February Medicaid and CHIP Monthly Applications and Eligibility Determinations Report, Released April 4, 2014; Accessed:; ASPE Health Insurance Marketplace: March Enrollment Report For the period: October 1, 2013 – March 1, 2014; March 11, 2014; Accessed:

Download Avalere’s full press release below.

For more information on Medicaid expansion, please contact Jenna Stento at

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