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Providers seeing increased flow of Medicaid patients as crisis continues

Ingrid Stiver Senior Manager, Health Research Institute, PwC US October 22, 2020

Medicaid enrollment increased 6.2% between February and June, with almost 4 million new enrollees, according to a new summary report from CMS detailing the pandemic’s impact on enrollment. Enrollment in the Children’s Health Insurance Program (CHIP) increased by 0.4%, or roughly 25,000 enrollees.

Enrollment in the programs swelled after enactment of the Families First Coronavirus Response Act (FFCRA), which offered states a 6.2-percentage-point increase to Medicaid funding dating back to Jan. 1 through the COVID-19 public health emergency if they agree to a series of requirements. Under FFCRA’s continuous coverage requirement, states are generally prohibited from terminating coverage for new beneficiaries and those who had coverage on March 18. The continuous coverage requirement likely is driving some of the increase in Medicaid enrollees.

Providers may see a modest swell of patients covered by Medicaid as the pandemic adds to enrollment and stems the usual churn of beneficiaries rolling on and off the program. The economic calamity triggered by the COVID-19 pandemic has led to historic job losses and a loss of insurance coverage for many Americans. Forty million Americans filed for unemployment insurance between March and May. In May, the Kaiser Family Foundation estimated that nearly 50% of those who could lose employer coverage during the pandemic would be eligible for Medicaid, roughly 30% would be eligible for subsidized coverage through the Affordable Care Act individual marketplaces, and the remaining 20% would be eligible for unsubsidized coverage.

The rise in share of Medicaid patients may reflect a deteriorating payer mix for 2020 for some providers. Many providers were operating on thin margins, with the pandemic’s resulting, albeit temporary, suspensions in non-emergent services and procedures. Some have been grappling with liquidity issues. Providers have received some financial relief via the CARES Act Provider Relief Fund and accelerated payments. (CMS, offering additional relief, at least for now, has delayed recoupment of these payments.)

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Trine K. Tsouderos

HRI Regulatory Center Leader, PwC US

Tel: +1 (312) 241 3824

Ingrid Stiver

Senior Manager, Health Research Institute, PwC US

Erin McCallister

Senior Manager, Health Research Institute, PwC US

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