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Calculated Shard: 146 (from laksa104)

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curl -X POST \
  'http://laksa146.int.ahrefs:8124/' \
  -H 'Content-Type: text/plain' \
  -H 'X-ClickHouse-Database: crawler3' \
  -H 'Authorization: Basic YXBpOg==' \
  -d 'SELECT getAhrefsURLFromUnparsed(src_unparsed) AS found_url, ifNull(toUnixTimestamp(download_stamp), 0) AS crawl_time, ifNull(toUnixTimestamp(props_url_first_seen), 0) AS first_indexed_time, download_http_code AS http_code, src_unparsed AS src_unparsed, src_root_hash AS src_root_hash, history_drop_reason AS history_drop_reason, meta_title AS meta_title, meta_descriptions AS meta_descriptions, attrs_boilerpipe_text AS attrs_boilerpipe_text, attrs_markdown AS attrs_markdown, attrs_readable_markdown AS attrs_readable_markdown, meta_canonical AS meta_canonical FROM crawler3.page_info_local FINAL PREWHERE (src_root_hash, src_unparsed) IN ((getAhrefsRootHashFromUnparsed(getAhrefsUnparsedNoserviceFromURL(\'https://www.kff.org/covid-19/growth-in-medicaid-mco-enrollment-during-the-covid-19-pandemic/\')), getAhrefsUnparsedNoserviceFromURL(\'https://www.kff.org/covid-19/growth-in-medicaid-mco-enrollment-during-the-covid-19-pandemic/\'))) FORMAT JSONEachRow'

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{"found_url":"https:\/\/www.kff.org\/covid-19\/growth-in-medicaid-mco-enrollment-during-the-covid-19-pandemic\/","crawl_time":1776736393,"first_indexed_time":1755963257,"http_code":200,"src_unparsed":"org,kff!www,\/covid-19\/growth-in-medicaid-mco-enrollment-during-the-covid-19-pandemic\/ s443","src_root_hash":"158852913627932146","history_drop_reason":null,"meta_title":"Growth in Medicaid MCO Enrollment during the COVID-19 Pandemic | KFF","meta_descriptions":["This data note looks at state Medicaid managed care enrollment data through March 2021 to assess the impact of the COVID-19 pandemic and economic crisis on Medicaid enrollment. Data collected for 29 states show that the rate of Medicaid managed care enrollment growth was 18.8% when comparing managed care enrollment from March 2020 through March 2021. The rate accelerated compared to March 2020 through September 2020 and reversed the trend seen from March 2019 to March 2020 when aggregate growth declined."],"attrs_boilerpipe_text":"This data note looks at state Medicaid managed care enrollment data through March 2021 to assess the impact of the COVID-19 pandemic and economic crisis on Medicaid enrollment. Data collected for 29 states show that the rate of Medicaid managed care enrollment growth was 18.8% when comparing managed care enrollment from March 2020 through March 2021 (Figure 1). The rate accelerated compared to March 2020 through September 2020 and reversed the trend seen from March 2019 to March 2020 when aggregate growth declined. Recent trends mirror\nnational enrollment trends\nthat show enrollment growth has been accelerating since the start of the pandemic. Enrollment growth is primarily attributable to the economic downturn as well as the\n“maintenance of eligibility” (MOE) requirements\ntied to a 6.2 percentage point increase in the federal match rate (FMAP) authorized by the Families First Coronavirus Response Act (FFCRA) – which prevents states from disenrolling Medicaid beneficiaries if they accept the additional federal funding.\nFigure 1: MCO Enrollment Growth Rates: March 2019 – March 2021\nWhy are recent state MCO enrollment data an important indicator?\nPreliminary national Medicaid and CHIP enrollment data collected by the Centers for Medicare and Medicaid Services (CMS) is lagged and currently available through\nJanuary 2021\n. These data show an increase in Medicaid and CHIP enrollment of 9.3 million or 13.1% from February 2020 through January 2021. Our\nKFF Medicaid Managed Care Tracker\ntracks Medicaid enrollment in comprehensive Medicaid managed care organizations (MCOs) for all states that make these data publicly available. These data are updated in our tracker annually with March enrollment data, but given changes related to the pandemic we have updated the tracker more frequently to provide a more current look at enrollment trends.\nThese data are informative as\nmore than two-thirds\nof beneficiaries nationally receive most or all of their care through risk-based MCOs and almost two-thirds of states that contract with MCOs\nenroll 75% or more of their Medicaid beneficiaries in MCOs\n. Children and nonelderly adults are groups more likely to be affected by changes in the economy and\nare also more likely to be enrolled in Medicaid MCOs\n. Increased enrollment in MCOs is directly tied to spending without immediate regard to utilization of care. While utilization may be rebounding, it\ndecreased\nduring the pandemic for non-urgent care. However, since states make upfront capitation payments to MCOs to provide access to a range of services, analyzing growth in Medicaid MCO enrollment specifically is valuable beyond signaling broader trends in Medicaid enrollment.\nWhat were the trends prior to the pandemic?\nData show that prior to the pandemic, there was an aggregate enrollment decline among reporting states. Specifically, among the 32 states reporting data for March 2019 and March 2020 (of the 40 states, including DC, that contract with MCOs), there was an aggregate decline of 1.3% (Table 1). The median change was essentially flat, showing a 0.4% increase, and there were a relatively equal number of states reporting enrollment gains and enrollment declines (17 and 15 respectively). In 2018, these states accounted for \nover 90% of the total share\n of enrollment in Medicaid MCOs nationally.\nWhat are the more recent trends?\nNegative growth seen from March 2019 to March 2020 reversed and started to accelerate following the start of the COVID-19 pandemic. Among states that reported data in the respective months, when compared to March 2020, states saw an increase in enrollment growth of 4.1% in May 2020, 11.3% in September 2020, 15.3% in December 2020, and 18.8% in March 2021 with similar median growth rates in each time period (Figure 1).\n1\n  Growth rates from March 2020 to March 2021 across states ranged from 9.7% (Tennessee) to 37.0% (Nevada) (Figure 2).\nOverall growth in Medicaid enrollment likely reflects both changes in the economy, as people experience income and job loss and become eligible for and enroll in Medicaid coverage, and the FFCRA MOE provisions that require states to ensure continuous coverage for current Medicaid enrollees through the end of the month in which the PHE ends. There is significant variation in MCO enrollment growth across states; however, the variation appears to align with the variation seen in overall Medicaid enrollment growth rates across states.\nFigure 2: Percent Growth in Medicaid MCO Enrollment: March 2020 – March 2021\nParent firms, firms that own Medicaid MCOs in two or more states, have seen large increases in both enrollment and market share. As of July 2018 (the latest period with national data) six parent firms – UnitedHealth Group, Centene, Anthem, Molina, Aetna, and WellCare –\naccounted for over 47% of all Medicaid MCO enrollment\n. In November 2018, Aetna was acquired by CVS and in 2020, WellCare was acquired by Centene. From March 2020 to March 2021, overall Medicaid MCO enrollment increased by around 8.3 million enrollees of which the five parent firms accounted for almost 60% (Figure 3).\nFigure 3: Five Fortune 500 firms made almost 60% of the increase in MCO enrollment in 28 states from March 2020 – March 2021\nWhat should we watch going forward?\nLast summer, states projected that the MOE requirements and the continued economic downturn would maintain upward pressure on Medicaid enrollment in\nFY 2021\n(which ends June 30, 2021 for most states). While the current PHE declaration \nexpires\n 90 days from April 21, 2021, the Biden Administration has notified states that the PHE will likely remain in place throughout CY 2021 and that states will receive 60 days-notice before the end of the PHE. Additionally, with the Biden administration’s executive order to reopen the enrollment in the federal ACA Marketplace and the “no wrong door” application process,\nmore individuals may enroll in Medicaid coverage\nin the coming months.\n2\n  Enrollment may continue to grow while the MOE remains in place, during ACA open enrollment period that continues through August 15, 2021, and because\nenrollment growth may be lagged\nand continue even as national indicators begin to improve. This effect was observed following the end of the Great Recession in 2009 when Medicaid\nspending and enrollment\ncontinued to grow in 2010 and 2011. Continued growth in MCO enrollment could put pressure on overall state budgets. Therefore, states may want to continue to review utilization patterns as well as options to mitigate risks related to potential overpayments to MCOs.\nTable 1: Change in MCO Enrollment, March 2019 – March 2021\nEnrollment\nPercent Change\nState\nMarch 2019\nMarch 2020\nSeptember 2020\nMarch 2021\nMarch 2019 – March 2020\nMarch 2020 – September 2020\nMarch 2020 – March 2021\nOverall\n33 States Reporting\n33 States Reporting\n34 States Reporting\n29 States Reporting\n-1.3%\n11.3%\n18.8%\nArizona\n1,514,431\n1,517,228\n1,692,948\n1,800,529\n0.2%\n11.6%\n18.7%\nCalifornia\n10,452,386\n10,166,418\n10,857,552\n11,353,379\n-2.7%\n6.8%\n11.7%\nColorado\n110,965\n121,435\n138,312\n151,270\n9.4%\n13.9%\n24.6%\nDelaware\n200,194\n198,477\n213,216\nNR\n-0.9%\n7.4%\n–\nDistrict of Columbia\n194,896\n182,530\n200,049\n225,989\n-6.3%\n9.6%\n23.8%\nFlorida\n2,975,428\n2,906,434\n3,389,302\n3,677,298\n-2.3%\n16.6%\n26.5%\nGeorgia\n1,360,907\n1,387,641\n1,607,743\n1,696,673\n2.0%\n15.9%\n22.3%\nHawaii\n344,254\n340,541\n378,100\n407,422\n-1.1%\n11.0%\n19.6%\nIllinois\n2,144,696\n2,197,501\n2,549,635\n2,691,162\n2.5%\n16.0%\n22.5%\nIndiana\n1,078,209\n1,116,114\n1,307,448\n1,458,069\n3.5%\n17.1%\n30.6%\nIowa\n562,432\n578,226\n635,790\n675,185\n2.8%\n10.0%\n16.8%\nKansas\n380,022\n389,754\n419,109\n440,681\n2.6%\n7.5%\n13.1%\nKentucky\n1,233,360\n1,195,787\n1,305,929\n1,500,939\n-3.0%\n9.2%\n25.5%\nLouisiana\n1,533,075\nNR\n1,611,537\n1,706,781\n–\n–\n–\nMaryland\n1,197,185\n1,212,628\n1,294,436\n1,364,957\n1.3%\n6.7%\n12.6%\nMassachusetts\n695,290\n717,029\n787,379\nNR\n3.1%\n9.8%\n–\nMichigan\n1,760,122\n1,772,762\n1,975,341\n2,105,078\n0.7%\n11.4%\n18.7%\nMinnesota\n835,528\n841,347\n967,376\n1,033,751\n0.7%\n15.0%\n22.9%\nMississippi\n437,194\n431,523\n462,070\n485,435\n-1.3%\n7.1%\n12.5%\nMissouri\n676,539\n549,116\n680,421\n744,224\n-18.8%\n23.9%\n35.5%\nNebraska\n233,431\n232,991\n257,589\n295,175\n-0.2%\n10.6%\n26.7%\nNevada\n466,227\n434,252\n543,650\n595,001\n-6.9%\n25.2%\n37.0%\nNew Mexico\n660,646\n674,343\n727,421\n762,714\n2.1%\n7.9%\n13.1%\nNew York\n4,344,939\n4,210,483\n4,776,592\n5,054,373\n-3.1%\n13.4%\n20.0%\nNorth Dakota\nNR\n19,814\n22,593\nNR\n–\n14.0%\n–\nOhio\n2,344,075\n2,055,454\nNR\nNR\n-12.3%\n–\n–\nOregon\n853,185\n898,749\n994,631\n1,068,563\n5.3%\n10.7%\n18.9%\nPennsylvania\n2,274,092\n2,235,532\n2,461,326\n2,626,383\n-1.7%\n10.1%\n17.5%\nSouth Carolina\n794,184\n788,253\n872,574\n934,517\n-0.7%\n10.7%\n18.6%\nTennessee\n1,389,600\n1,421,145\n1,493,081\n1,558,446\n2.3%\n5.1%\n9.7%\nTexas\n3,688,147\n3,614,486\n4,126,940\n4,504,285\n-2.0%\n14.2%\n24.6%\nVirginia\nNR\nNR\n1,513,132\n1,634,786\n–\n–\n–\nWashington\n1,332,557\n1,529,039\n1,645,684\n1,734,004\n14.7%\n7.6%\n13.4%\nWest Virginia\n390,546\n402,303\n437,061\n457,534\n3.0%\n8.6%\n13.7%\nWisconsin\n756,650\n766,477\n910,960\n995,094\n1.3%\n18.9%\n29.8%\nNOTES: Select time periods for percent change in MCO enrollment growth rates are shown in this table.“NR” – Not Reported. Methodology for reporting enrollment data varies across states: some states report point in time (PIT) counts while other states report monthly averages.AR, NH, NJ, RI, and UT did not report any data for any time periods.Aggregate growth rates were calculated using states that reported in both periods. From March 2019 – March 2020, 32 states reported in both periods. From March 2020 – September 2020, 32 states reported in both periods. From March – March 2021, 29 states reported in both periods.Data for DC in March 2021 were preliminary. Data for TX were preliminary and February 2021, while data for GA and NE were from January 2021 to represent March 2021 as those were the most up-to-date data available.SOURCES: KFF analysis of state Medicaid managed care enrollment reports.\nGrowth rates were calculated using states that reported in both periods. From March 2019 – March 2020, 32 states reported in both periods. From March 2020 – May 2020, 27 states reported in both periods. From March 2020 – September 2020, 32 states reported in both periods. From March – December 2020, 30 states reported in both periods. From March 2020 – March 2021, 29 states reported in both periods.\n↩︎\nThe Biden Administration originally reopened enrollment in the Federal ACA Marketplace from February 15 to May 15, 2021 but extended this period through August 15, 2021.\n↩︎","attrs_markdown":"[Skip to main content](https:\/\/www.kff.org\/covid-19\/growth-in-medicaid-mco-enrollment-during-the-covid-19-pandemic\/#main)\n\nThe independent source for health policy research, polling, and news.\n\nThe independent source for health policy research, polling, and news.\n\n[Subscribe](https:\/\/www.kff.org\/about-us\/email\/) [Follow Us](https:\/\/www.kff.org\/about-us\/follow-us\/) [Conference Centers](https:\/\/www.kff.org\/about-us\/conference-centers\/) [Donate](https:\/\/www.kff.org\/about-us\/support-our-work\/)\n\nSearch\n\n- [Topics](https:\/\/www.kff.org\/covid-19\/growth-in-medicaid-mco-enrollment-during-the-covid-19-pandemic\/)\n  Back\n  ***\n  ## Topics\n  ***\n  - [Affordable Care Act](https:\/\/www.kff.org\/topic\/affordable-care-act\/)\n  - 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[Beyond the Data Columns](https:\/\/www.kff.org\/series\/beyond-the-data\/)\n  - [View All](https:\/\/www.kff.org\/from-drew-altman\/)\n  \n  [About KFF](https:\/\/www.kff.org\/about-us\/)\n***\n[Follow Us](https:\/\/www.kff.org\/about-us\/follow-us\/) [Subscribe](https:\/\/www.kff.org\/about-us\/email\/)\n\nSearch\n\n[Home](https:\/\/www.kff.org\/) [Topics](https:\/\/www.kff.org\/topics\/) [COVID-19](https:\/\/www.kff.org\/topic\/covid-19\/)\n\n# Growth in Medicaid MCO Enrollment during the COVID-19 Pandemic\nAuthors:  Lina Stolyar, [Elizabeth Hinton](https:\/\/www.kff.org\/person\/elizabeth-hinton\/), Natalie Singer, and [Robin Rudowitz](https:\/\/www.kff.org\/person\/robin-rudowitz\/)\n\nPublished:\n\nJun 24, 2021\n\nPrint\n\n[Email](mailto:?subject=Growth%20in%20Medicaid%20MCO%20Enrollment%20during%20the%20COVID-19%20Pandemic&body=https%3A%2F%2Fwww.kff.org%2Fcovid-19%2Fgrowth-in-medicaid-mco-enrollment-during-the-covid-19-pandemic%2F)\n\nCopy Link\n\n[Add KFF on Google](https:\/\/google.com\/preferences\/source?q=kff.org)\n\nThis data note looks at state Medicaid managed care enrollment data through March 2021 to assess the impact of the COVID-19 pandemic and economic crisis on Medicaid enrollment. Data collected for 29 states show that the rate of Medicaid managed care enrollment growth was 18.8% when comparing managed care enrollment from March 2020 through March 2021 (Figure 1). The rate accelerated compared to March 2020 through September 2020 and reversed the trend seen from March 2019 to March 2020 when aggregate growth declined. Recent trends mirror [national enrollment trends](https:\/\/www.kff.org\/coronavirus-covid-19\/issue-brief\/analysis-of-recent-national-trends-in-medicaid-and-chip-enrollment\/) that show enrollment growth has been accelerating since the start of the pandemic. Enrollment growth is primarily attributable to the economic downturn as well as the [“maintenance of eligibility” (MOE) requirements](https:\/\/www.kff.org\/medicaid\/issue-brief\/medicaid-maintenance-of-eligibility-requirements-issues-to-watch-when-they-end\/) tied to a 6.2 percentage point increase in the federal match rate (FMAP) authorized by the Families First Coronavirus Response Act (FFCRA) – which prevents states from disenrolling Medicaid beneficiaries if they accept the additional federal funding.\n\n![](https:\/\/www.kff.org\/wp-content\/uploads\/sites\/7\/2021\/06\/9500-04-Figure-1-1.png?w=1024)\n\nFigure 1: MCO Enrollment Growth Rates: March 2019 – March 2021\n\n**Why are recent state MCO enrollment data an important indicator?** Preliminary national Medicaid and CHIP enrollment data collected by the Centers for Medicare and Medicaid Services (CMS) is lagged and currently available through [January 2021](https:\/\/www.kff.org\/coronavirus-covid-19\/issue-brief\/analysis-of-recent-national-trends-in-medicaid-and-chip-enrollment\/). These data show an increase in Medicaid and CHIP enrollment of 9.3 million or 13.1% from February 2020 through January 2021. Our [KFF Medicaid Managed Care Tracker](https:\/\/www.kff.org\/data-collection\/medicaid-managed-care-market-tracker\/) tracks Medicaid enrollment in comprehensive Medicaid managed care organizations (MCOs) for all states that make these data publicly available. These data are updated in our tracker annually with March enrollment data, but given changes related to the pandemic we have updated the tracker more frequently to provide a more current look at enrollment trends.\n\nThese data are informative as [more than two-thirds](https:\/\/www.kff.org\/other\/state-indicator\/total-medicaid-mco-enrollment\/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D) of beneficiaries nationally receive most or all of their care through risk-based MCOs and almost two-thirds of states that contract with MCOs [enroll 75% or more of their Medicaid beneficiaries in MCOs](https:\/\/www.kff.org\/other\/state-indicator\/total-medicaid-mco-enrollment\/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D). Children and nonelderly adults are groups more likely to be affected by changes in the economy and [are also more likely to be enrolled in Medicaid MCOs](https:\/\/www.kff.org\/medicaid\/state-indicator\/managed-care-penetration-rates-by-eligibility-group\/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D). Increased enrollment in MCOs is directly tied to spending without immediate regard to utilization of care. While utilization may be rebounding, it [decreased](https:\/\/www.healthsystemtracker.org\/chart-collection\/how-have-healthcare-utilization-and-spending-changed-so-far-during-the-coronavirus-pandemic\/#item-covidcostsuse_marchupdate_7) during the pandemic for non-urgent care. However, since states make upfront capitation payments to MCOs to provide access to a range of services, analyzing growth in Medicaid MCO enrollment specifically is valuable beyond signaling broader trends in Medicaid enrollment.\n\n**What were the trends prior to the pandemic?** Data show that prior to the pandemic, there was an aggregate enrollment decline among reporting states. Specifically, among the 32 states reporting data for March 2019 and March 2020 (of the 40 states, including DC, that contract with MCOs), there was an aggregate decline of 1.3% (Table 1). The median change was essentially flat, showing a 0.4% increase, and there were a relatively equal number of states reporting enrollment gains and enrollment declines (17 and 15 respectively). In 2018, these states accounted for [over 90% of the total share](https:\/\/www.medicaid.gov\/medicaid\/managed-care\/downloads\/2018-medicaid-managed-care-enrollment-report.pdf) of enrollment in Medicaid MCOs nationally.\n\n**What are the more recent trends?** Negative growth seen from March 2019 to March 2020 reversed and started to accelerate following the start of the COVID-19 pandemic. Among states that reported data in the respective months, when compared to March 2020, states saw an increase in enrollment growth of 4.1% in May 2020, 11.3% in September 2020, 15.3% in December 2020, and 18.8% in March 2021 with similar median growth rates in each time period (Figure 1).[1](https:\/\/www.kff.org\/covid-19\/growth-in-medicaid-mco-enrollment-during-the-covid-19-pandemic\/#493912ba-5e3a-4694-aa2f-8d6ba7ee9ffd) Growth rates from March 2020 to March 2021 across states ranged from 9.7% (Tennessee) to 37.0% (Nevada) (Figure 2).\n\nOverall growth in Medicaid enrollment likely reflects both changes in the economy, as people experience income and job loss and become eligible for and enroll in Medicaid coverage, and the FFCRA MOE provisions that require states to ensure continuous coverage for current Medicaid enrollees through the end of the month in which the PHE ends. There is significant variation in MCO enrollment growth across states; however, the variation appears to align with the variation seen in overall Medicaid enrollment growth rates across states.\n\n![](https:\/\/www.kff.org\/wp-content\/uploads\/sites\/7\/2021\/06\/9500-04-Figure-2-1.png?w=1024)\n\nFigure 2: Percent Growth in Medicaid MCO Enrollment: March 2020 – March 2021\n\nParent firms, firms that own Medicaid MCOs in two or more states, have seen large increases in both enrollment and market share. As of July 2018 (the latest period with national data) six parent firms – UnitedHealth Group, Centene, Anthem, Molina, Aetna, and WellCare – [accounted for over 47% of all Medicaid MCO enrollment](https:\/\/www.kff.org\/medicaid\/issue-brief\/10-things-to-know-about-medicaid-managed-care\/). In November 2018, Aetna was acquired by CVS and in 2020, WellCare was acquired by Centene. From March 2020 to March 2021, overall Medicaid MCO enrollment increased by around 8.3 million enrollees of which the five parent firms accounted for almost 60% (Figure 3).\n\n![](https:\/\/www.kff.org\/wp-content\/uploads\/sites\/7\/2021\/06\/9500-04-Figure-3.png?w=1024)\n\nFigure 3: Five Fortune 500 firms made almost 60% of the increase in MCO enrollment in 28 states from March 2020 – March 2021\n\n**What should we watch going forward?** Last summer, states projected that the MOE requirements and the continued economic downturn would maintain upward pressure on Medicaid enrollment in [FY 2021](https:\/\/www.kff.org\/medicaid\/issue-brief\/medicaid-enrollment-spending-growth-fy-2020-2021\/) (which ends June 30, 2021 for most states). While the current PHE declaration [expires](https:\/\/www.phe.gov\/emergency\/news\/healthactions\/phe\/Pages\/COVID-15April2021.aspx) 90 days from April 21, 2021, the Biden Administration has notified states that the PHE will likely remain in place throughout CY 2021 and that states will receive 60 days-notice before the end of the PHE. Additionally, with the Biden administration’s executive order to reopen the enrollment in the federal ACA Marketplace and the “no wrong door” application process, [more individuals may enroll in Medicaid coverage](https:\/\/www.kff.org\/policy-watch\/aca-open-enrollment-matters-for-medicaid-coverage-too\/) in the coming months.[2](https:\/\/www.kff.org\/covid-19\/growth-in-medicaid-mco-enrollment-during-the-covid-19-pandemic\/#ea9d6ceb-6924-43c7-87a8-978cc09032f1) Enrollment may continue to grow while the MOE remains in place, during ACA open enrollment period that continues through August 15, 2021, and because [enrollment growth may be lagged](https:\/\/www.healthaffairs.org\/do\/10.1377\/hblog20200806.165269\/full\/) and continue even as national indicators begin to improve. This effect was observed following the end of the Great Recession in 2009 when Medicaid [spending and enrollment](https:\/\/www.kff.org\/medicaid\/issue-brief\/medicaid-enrollment-spending-growth-fy-2020-2021\/#:~:text=Across%20all%20reporting%20states%2C%20states,expenditure%20growth%20in%20FY%202021.) continued to grow in 2010 and 2011. Continued growth in MCO enrollment could put pressure on overall state budgets. Therefore, states may want to continue to review utilization patterns as well as options to mitigate risks related to potential overpayments to MCOs.\n\n|   |   |   |   |   |   |   |   |\n|---|---|---|---|---|---|---|---|\n| Table 1: Change in MCO Enrollment, March 2019 – March 2021 |   |   |   |   |   |   |   |\n|   | **Enrollment** | **Percent Change** |   |   |   |   |   |\n| **State** | **March 2019** | **March 2020** | **September 2020** | **March 2021** | **March 2019 – March 2020** | **March 2020 – September 2020** | **March 2020 – March 2021** |\n| Overall | 33 States Reporting | 33 States Reporting | 34 States Reporting | 29 States Reporting | \\-1.3% | 11\\.3% | 18\\.8% |\n| Arizona | 1,514,431 | 1,517,228 | 1,692,948 | 1,800,529 | 0\\.2% | 11\\.6% | 18\\.7% |\n| California | 10,452,386 | 10,166,418 | 10,857,552 | 11,353,379 | \\-2.7% | 6\\.8% | 11\\.7% |\n| Colorado | 110,965 | 121,435 | 138,312 | 151,270 | 9\\.4% | 13\\.9% | 24\\.6% |\n| Delaware | 200,194 | 198,477 | 213,216 | NR | \\-0.9% | 7\\.4% | – |\n| District of Columbia | 194,896 | 182,530 | 200,049 | 225,989 | \\-6.3% | 9\\.6% | 23\\.8% |\n| Florida | 2,975,428 | 2,906,434 | 3,389,302 | 3,677,298 | \\-2.3% | 16\\.6% | 26\\.5% |\n| Georgia | 1,360,907 | 1,387,641 | 1,607,743 | 1,696,673 | 2\\.0% | 15\\.9% | 22\\.3% |\n| Hawaii | 344,254 | 340,541 | 378,100 | 407,422 | \\-1.1% | 11\\.0% | 19\\.6% |\n| Illinois | 2,144,696 | 2,197,501 | 2,549,635 | 2,691,162 | 2\\.5% | 16\\.0% | 22\\.5% |\n| Indiana | 1,078,209 | 1,116,114 | 1,307,448 | 1,458,069 | 3\\.5% | 17\\.1% | 30\\.6% |\n| Iowa | 562,432 | 578,226 | 635,790 | 675,185 | 2\\.8% | 10\\.0% | 16\\.8% |\n| Kansas | 380,022 | 389,754 | 419,109 | 440,681 | 2\\.6% | 7\\.5% | 13\\.1% |\n| Kentucky | 1,233,360 | 1,195,787 | 1,305,929 | 1,500,939 | \\-3.0% | 9\\.2% | 25\\.5% |\n| Louisiana | 1,533,075 | NR | 1,611,537 | 1,706,781 | – | – | – |\n| Maryland | 1,197,185 | 1,212,628 | 1,294,436 | 1,364,957 | 1\\.3% | 6\\.7% | 12\\.6% |\n| Massachusetts | 695,290 | 717,029 | 787,379 | NR | 3\\.1% | 9\\.8% | – |\n| Michigan | 1,760,122 | 1,772,762 | 1,975,341 | 2,105,078 | 0\\.7% | 11\\.4% | 18\\.7% |\n| Minnesota | 835,528 | 841,347 | 967,376 | 1,033,751 | 0\\.7% | 15\\.0% | 22\\.9% |\n| Mississippi | 437,194 | 431,523 | 462,070 | 485,435 | \\-1.3% | 7\\.1% | 12\\.5% |\n| Missouri | 676,539 | 549,116 | 680,421 | 744,224 | \\-18.8% | 23\\.9% | 35\\.5% |\n| Nebraska | 233,431 | 232,991 | 257,589 | 295,175 | \\-0.2% | 10\\.6% | 26\\.7% |\n| Nevada | 466,227 | 434,252 | 543,650 | 595,001 | \\-6.9% | 25\\.2% | 37\\.0% |\n| New Mexico | 660,646 | 674,343 | 727,421 | 762,714 | 2\\.1% | 7\\.9% | 13\\.1% |\n| New York | 4,344,939 | 4,210,483 | 4,776,592 | 5,054,373 | \\-3.1% | 13\\.4% | 20\\.0% |\n| North Dakota | NR | 19,814 | 22,593 | NR | – | 14\\.0% | – |\n| Ohio | 2,344,075 | 2,055,454 | NR | NR | \\-12.3% | – | – |\n| Oregon | 853,185 | 898,749 | 994,631 | 1,068,563 | 5\\.3% | 10\\.7% | 18\\.9% |\n| Pennsylvania | 2,274,092 | 2,235,532 | 2,461,326 | 2,626,383 | \\-1.7% | 10\\.1% | 17\\.5% |\n| South Carolina | 794,184 | 788,253 | 872,574 | 934,517 | \\-0.7% | 10\\.7% | 18\\.6% |\n| Tennessee | 1,389,600 | 1,421,145 | 1,493,081 | 1,558,446 | 2\\.3% | 5\\.1% | 9\\.7% |\n| Texas | 3,688,147 | 3,614,486 | 4,126,940 | 4,504,285 | \\-2.0% | 14\\.2% | 24\\.6% |\n| Virginia | NR | NR | 1,513,132 | 1,634,786 | – | – | – |\n| Washington | 1,332,557 | 1,529,039 | 1,645,684 | 1,734,004 | 14\\.7% | 7\\.6% | 13\\.4% |\n| West Virginia | 390,546 | 402,303 | 437,061 | 457,534 | 3\\.0% | 8\\.6% | 13\\.7% |\n| Wisconsin | 756,650 | 766,477 | 910,960 | 995,094 | 1\\.3% | 18\\.9% | 29\\.8% |\n| NOTES: Select time periods for percent change in MCO enrollment growth rates are shown in this table.“NR” – Not Reported. Methodology for reporting enrollment data varies across states: some states report point in time (PIT) counts while other states report monthly averages.AR, NH, NJ, RI, and UT did not report any data for any time periods.Aggregate growth rates were calculated using states that reported in both periods. From March 2019 – March 2020, 32 states reported in both periods. From March 2020 – September 2020, 32 states reported in both periods. From March – March 2021, 29 states reported in both periods.Data for DC in March 2021 were preliminary. Data for TX were preliminary and February 2021, while data for GA and NE were from January 2021 to represent March 2021 as those were the most up-to-date data available.SOURCES: KFF analysis of state Medicaid managed care enrollment reports. |   |   |   |   |   |   |   |\n\n1. Growth rates were calculated using states that reported in both periods. From March 2019 – March 2020, 32 states reported in both periods. From March 2020 – May 2020, 27 states reported in both periods. From March 2020 – September 2020, 32 states reported in both periods. From March – December 2020, 30 states reported in both periods. From March 2020 – March 2021, 29 states reported in both periods. [↩︎](https:\/\/www.kff.org\/covid-19\/growth-in-medicaid-mco-enrollment-during-the-covid-19-pandemic\/#493912ba-5e3a-4694-aa2f-8d6ba7ee9ffd-link)\n2. The Biden Administration originally reopened enrollment in the Federal ACA Marketplace from February 15 to May 15, 2021 but extended this period through August 15, 2021. [↩︎](https:\/\/www.kff.org\/covid-19\/growth-in-medicaid-mco-enrollment-during-the-covid-19-pandemic\/#ea9d6ceb-6924-43c7-87a8-978cc09032f1-link)\n\nMore On\n\n[COVID-19](https:\/\/www.kff.org\/topic\/covid-19\/)   [Medicaid](https:\/\/www.kff.org\/topic\/medicaid\/)   [Enrollment](https:\/\/www.kff.org\/tag\/enrollment\/)   [Managed Care](https:\/\/www.kff.org\/tag\/managed-care\/)\n\n## Also of Interest\n### [Medicaid Managed Care Reporting and Transparency: Managed Care Program Annual Reports](https:\/\/www.kff.org\/medicaid\/medicaid-managed-care-reporting-and-transparency-managed-care-program-annual-reports\/)\n### [10 Things to Know About Medicaid Managed Care](https:\/\/www.kff.org\/medicaid\/10-things-to-know-about-medicaid-managed-care\/)\n### [A Look at Medicaid Enrollment and Finances of the Five Largest Medicaid Managed Care Plans](https:\/\/www.kff.org\/medicaid\/a-look-at-medicaid-enrollment-and-finances-of-the-five-largest-medicaid-managed-care-plans\/)\n\n## More On\n- [COVID-19](https:\/\/www.kff.org\/topic\/covid-19\/)\n- [Medicaid](https:\/\/www.kff.org\/topic\/medicaid\/)\n- [Enrollment](https:\/\/www.kff.org\/tag\/enrollment\/)\n- [Managed Care](https:\/\/www.kff.org\/tag\/managed-care\/)\n\n[View all Topics](https:\/\/www.kff.org\/topics\/)\n\n- [Policy Research](https:\/\/www.kff.org\/policy-research\/)\n- [Polling](https:\/\/www.kff.org\/topic\/public-opinion)\n- [Health News](https:\/\/www.kffhealthnews.org\/)\n\nAbout Us\n\n- [Conference Centers](https:\/\/www.kff.org\/about-us\/conference-centers\/)\n- [Join Our Team](https:\/\/www.kff.org\/about-us\/employment-opportunities\/)\n- [Contact Us](https:\/\/www.kff.org\/about-us\/contact-us\/)\n- [Follow Us](https:\/\/www.kff.org\/about-us\/follow-us\/)\n\n### Sign up for emails\nJoin our email list for regular updates based on your personal preferences.\n\n[Sign up](https:\/\/www.kff.org\/about-us\/email\/)\n\n- [Privacy Policy](https:\/\/www.kff.org\/about-us\/privacy-policy\/)\n- [Citations and Reprints](https:\/\/www.kff.org\/about-us\/permissions-citations-reprints\/)\n\n© 2026 KFF","attrs_readable_markdown":"This data note looks at state Medicaid managed care enrollment data through March 2021 to assess the impact of the COVID-19 pandemic and economic crisis on Medicaid enrollment. Data collected for 29 states show that the rate of Medicaid managed care enrollment growth was 18.8% when comparing managed care enrollment from March 2020 through March 2021 (Figure 1). The rate accelerated compared to March 2020 through September 2020 and reversed the trend seen from March 2019 to March 2020 when aggregate growth declined. Recent trends mirror [national enrollment trends](https:\/\/www.kff.org\/coronavirus-covid-19\/issue-brief\/analysis-of-recent-national-trends-in-medicaid-and-chip-enrollment\/) that show enrollment growth has been accelerating since the start of the pandemic. Enrollment growth is primarily attributable to the economic downturn as well as the [“maintenance of eligibility” (MOE) requirements](https:\/\/www.kff.org\/medicaid\/issue-brief\/medicaid-maintenance-of-eligibility-requirements-issues-to-watch-when-they-end\/) tied to a 6.2 percentage point increase in the federal match rate (FMAP) authorized by the Families First Coronavirus Response Act (FFCRA) – which prevents states from disenrolling Medicaid beneficiaries if they accept the additional federal funding.\n\n![](https:\/\/www.kff.org\/wp-content\/uploads\/sites\/7\/2021\/06\/9500-04-Figure-1-1.png?w=1024)\n\nFigure 1: MCO Enrollment Growth Rates: March 2019 – March 2021\n\n**Why are recent state MCO enrollment data an important indicator?** Preliminary national Medicaid and CHIP enrollment data collected by the Centers for Medicare and Medicaid Services (CMS) is lagged and currently available through [January 2021](https:\/\/www.kff.org\/coronavirus-covid-19\/issue-brief\/analysis-of-recent-national-trends-in-medicaid-and-chip-enrollment\/). These data show an increase in Medicaid and CHIP enrollment of 9.3 million or 13.1% from February 2020 through January 2021. Our [KFF Medicaid Managed Care Tracker](https:\/\/www.kff.org\/data-collection\/medicaid-managed-care-market-tracker\/) tracks Medicaid enrollment in comprehensive Medicaid managed care organizations (MCOs) for all states that make these data publicly available. These data are updated in our tracker annually with March enrollment data, but given changes related to the pandemic we have updated the tracker more frequently to provide a more current look at enrollment trends.\n\nThese data are informative as [more than two-thirds](https:\/\/www.kff.org\/other\/state-indicator\/total-medicaid-mco-enrollment\/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D) of beneficiaries nationally receive most or all of their care through risk-based MCOs and almost two-thirds of states that contract with MCOs [enroll 75% or more of their Medicaid beneficiaries in MCOs](https:\/\/www.kff.org\/other\/state-indicator\/total-medicaid-mco-enrollment\/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D). Children and nonelderly adults are groups more likely to be affected by changes in the economy and [are also more likely to be enrolled in Medicaid MCOs](https:\/\/www.kff.org\/medicaid\/state-indicator\/managed-care-penetration-rates-by-eligibility-group\/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D). Increased enrollment in MCOs is directly tied to spending without immediate regard to utilization of care. While utilization may be rebounding, it [decreased](https:\/\/www.healthsystemtracker.org\/chart-collection\/how-have-healthcare-utilization-and-spending-changed-so-far-during-the-coronavirus-pandemic\/#item-covidcostsuse_marchupdate_7) during the pandemic for non-urgent care. However, since states make upfront capitation payments to MCOs to provide access to a range of services, analyzing growth in Medicaid MCO enrollment specifically is valuable beyond signaling broader trends in Medicaid enrollment.\n\n**What were the trends prior to the pandemic?** Data show that prior to the pandemic, there was an aggregate enrollment decline among reporting states. Specifically, among the 32 states reporting data for March 2019 and March 2020 (of the 40 states, including DC, that contract with MCOs), there was an aggregate decline of 1.3% (Table 1). The median change was essentially flat, showing a 0.4% increase, and there were a relatively equal number of states reporting enrollment gains and enrollment declines (17 and 15 respectively). In 2018, these states accounted for [over 90% of the total share](https:\/\/www.medicaid.gov\/medicaid\/managed-care\/downloads\/2018-medicaid-managed-care-enrollment-report.pdf) of enrollment in Medicaid MCOs nationally.\n\n**What are the more recent trends?** Negative growth seen from March 2019 to March 2020 reversed and started to accelerate following the start of the COVID-19 pandemic. Among states that reported data in the respective months, when compared to March 2020, states saw an increase in enrollment growth of 4.1% in May 2020, 11.3% in September 2020, 15.3% in December 2020, and 18.8% in March 2021 with similar median growth rates in each time period (Figure 1).[1](https:\/\/www.kff.org\/covid-19\/growth-in-medicaid-mco-enrollment-during-the-covid-19-pandemic\/#493912ba-5e3a-4694-aa2f-8d6ba7ee9ffd) Growth rates from March 2020 to March 2021 across states ranged from 9.7% (Tennessee) to 37.0% (Nevada) (Figure 2).\n\nOverall growth in Medicaid enrollment likely reflects both changes in the economy, as people experience income and job loss and become eligible for and enroll in Medicaid coverage, and the FFCRA MOE provisions that require states to ensure continuous coverage for current Medicaid enrollees through the end of the month in which the PHE ends. There is significant variation in MCO enrollment growth across states; however, the variation appears to align with the variation seen in overall Medicaid enrollment growth rates across states.\n\n![](https:\/\/www.kff.org\/wp-content\/uploads\/sites\/7\/2021\/06\/9500-04-Figure-2-1.png?w=1024)\n\nFigure 2: Percent Growth in Medicaid MCO Enrollment: March 2020 – March 2021\n\nParent firms, firms that own Medicaid MCOs in two or more states, have seen large increases in both enrollment and market share. As of July 2018 (the latest period with national data) six parent firms – UnitedHealth Group, Centene, Anthem, Molina, Aetna, and WellCare – [accounted for over 47% of all Medicaid MCO enrollment](https:\/\/www.kff.org\/medicaid\/issue-brief\/10-things-to-know-about-medicaid-managed-care\/). In November 2018, Aetna was acquired by CVS and in 2020, WellCare was acquired by Centene. From March 2020 to March 2021, overall Medicaid MCO enrollment increased by around 8.3 million enrollees of which the five parent firms accounted for almost 60% (Figure 3).\n\n![](https:\/\/www.kff.org\/wp-content\/uploads\/sites\/7\/2021\/06\/9500-04-Figure-3.png?w=1024)\n\nFigure 3: Five Fortune 500 firms made almost 60% of the increase in MCO enrollment in 28 states from March 2020 – March 2021\n\n**What should we watch going forward?** Last summer, states projected that the MOE requirements and the continued economic downturn would maintain upward pressure on Medicaid enrollment in [FY 2021](https:\/\/www.kff.org\/medicaid\/issue-brief\/medicaid-enrollment-spending-growth-fy-2020-2021\/) (which ends June 30, 2021 for most states). While the current PHE declaration [expires](https:\/\/www.phe.gov\/emergency\/news\/healthactions\/phe\/Pages\/COVID-15April2021.aspx) 90 days from April 21, 2021, the Biden Administration has notified states that the PHE will likely remain in place throughout CY 2021 and that states will receive 60 days-notice before the end of the PHE. Additionally, with the Biden administration’s executive order to reopen the enrollment in the federal ACA Marketplace and the “no wrong door” application process, [more individuals may enroll in Medicaid coverage](https:\/\/www.kff.org\/policy-watch\/aca-open-enrollment-matters-for-medicaid-coverage-too\/) in the coming months.[2](https:\/\/www.kff.org\/covid-19\/growth-in-medicaid-mco-enrollment-during-the-covid-19-pandemic\/#ea9d6ceb-6924-43c7-87a8-978cc09032f1) Enrollment may continue to grow while the MOE remains in place, during ACA open enrollment period that continues through August 15, 2021, and because [enrollment growth may be lagged](https:\/\/www.healthaffairs.org\/do\/10.1377\/hblog20200806.165269\/full\/) and continue even as national indicators begin to improve. This effect was observed following the end of the Great Recession in 2009 when Medicaid [spending and enrollment](https:\/\/www.kff.org\/medicaid\/issue-brief\/medicaid-enrollment-spending-growth-fy-2020-2021\/#:~:text=Across%20all%20reporting%20states%2C%20states,expenditure%20growth%20in%20FY%202021.) continued to grow in 2010 and 2011. Continued growth in MCO enrollment could put pressure on overall state budgets. Therefore, states may want to continue to review utilization patterns as well as options to mitigate risks related to potential overpayments to MCOs.\n\n|   |   |   |   |   |   |   |   |\n|---|---|---|---|---|---|---|---|\n| Table 1: Change in MCO Enrollment, March 2019 – March 2021 |   |   |   |   |   |   |   |\n|   | **Enrollment** | **Percent Change** |   |   |   |   |   |\n| **State** | **March 2019** | **March 2020** | **September 2020** | **March 2021** | **March 2019 – March 2020** | **March 2020 – September 2020** | **March 2020 – March 2021** |\n| Overall | 33 States Reporting | 33 States Reporting | 34 States Reporting | 29 States Reporting | \\-1.3% | 11\\.3% | 18\\.8% |\n| Arizona | 1,514,431 | 1,517,228 | 1,692,948 | 1,800,529 | 0\\.2% | 11\\.6% | 18\\.7% |\n| California | 10,452,386 | 10,166,418 | 10,857,552 | 11,353,379 | \\-2.7% | 6\\.8% | 11\\.7% |\n| Colorado | 110,965 | 121,435 | 138,312 | 151,270 | 9\\.4% | 13\\.9% | 24\\.6% |\n| Delaware | 200,194 | 198,477 | 213,216 | NR | \\-0.9% | 7\\.4% | – |\n| District of Columbia | 194,896 | 182,530 | 200,049 | 225,989 | \\-6.3% | 9\\.6% | 23\\.8% |\n| Florida | 2,975,428 | 2,906,434 | 3,389,302 | 3,677,298 | \\-2.3% | 16\\.6% | 26\\.5% |\n| Georgia | 1,360,907 | 1,387,641 | 1,607,743 | 1,696,673 | 2\\.0% | 15\\.9% | 22\\.3% |\n| Hawaii | 344,254 | 340,541 | 378,100 | 407,422 | \\-1.1% | 11\\.0% | 19\\.6% |\n| Illinois | 2,144,696 | 2,197,501 | 2,549,635 | 2,691,162 | 2\\.5% | 16\\.0% | 22\\.5% |\n| Indiana | 1,078,209 | 1,116,114 | 1,307,448 | 1,458,069 | 3\\.5% | 17\\.1% | 30\\.6% |\n| Iowa | 562,432 | 578,226 | 635,790 | 675,185 | 2\\.8% | 10\\.0% | 16\\.8% |\n| Kansas | 380,022 | 389,754 | 419,109 | 440,681 | 2\\.6% | 7\\.5% | 13\\.1% |\n| Kentucky | 1,233,360 | 1,195,787 | 1,305,929 | 1,500,939 | \\-3.0% | 9\\.2% | 25\\.5% |\n| Louisiana | 1,533,075 | NR | 1,611,537 | 1,706,781 | – | – | – |\n| Maryland | 1,197,185 | 1,212,628 | 1,294,436 | 1,364,957 | 1\\.3% | 6\\.7% | 12\\.6% |\n| Massachusetts | 695,290 | 717,029 | 787,379 | NR | 3\\.1% | 9\\.8% | – |\n| Michigan | 1,760,122 | 1,772,762 | 1,975,341 | 2,105,078 | 0\\.7% | 11\\.4% | 18\\.7% |\n| Minnesota | 835,528 | 841,347 | 967,376 | 1,033,751 | 0\\.7% | 15\\.0% | 22\\.9% |\n| Mississippi | 437,194 | 431,523 | 462,070 | 485,435 | \\-1.3% | 7\\.1% | 12\\.5% |\n| Missouri | 676,539 | 549,116 | 680,421 | 744,224 | \\-18.8% | 23\\.9% | 35\\.5% |\n| Nebraska | 233,431 | 232,991 | 257,589 | 295,175 | \\-0.2% | 10\\.6% | 26\\.7% |\n| Nevada | 466,227 | 434,252 | 543,650 | 595,001 | \\-6.9% | 25\\.2% | 37\\.0% |\n| New Mexico | 660,646 | 674,343 | 727,421 | 762,714 | 2\\.1% | 7\\.9% | 13\\.1% |\n| New York | 4,344,939 | 4,210,483 | 4,776,592 | 5,054,373 | \\-3.1% | 13\\.4% | 20\\.0% |\n| North Dakota | NR | 19,814 | 22,593 | NR | – | 14\\.0% | – |\n| Ohio | 2,344,075 | 2,055,454 | NR | NR | \\-12.3% | – | – |\n| Oregon | 853,185 | 898,749 | 994,631 | 1,068,563 | 5\\.3% | 10\\.7% | 18\\.9% |\n| Pennsylvania | 2,274,092 | 2,235,532 | 2,461,326 | 2,626,383 | \\-1.7% | 10\\.1% | 17\\.5% |\n| South Carolina | 794,184 | 788,253 | 872,574 | 934,517 | \\-0.7% | 10\\.7% | 18\\.6% |\n| Tennessee | 1,389,600 | 1,421,145 | 1,493,081 | 1,558,446 | 2\\.3% | 5\\.1% | 9\\.7% |\n| Texas | 3,688,147 | 3,614,486 | 4,126,940 | 4,504,285 | \\-2.0% | 14\\.2% | 24\\.6% |\n| Virginia | NR | NR | 1,513,132 | 1,634,786 | – | – | – |\n| Washington | 1,332,557 | 1,529,039 | 1,645,684 | 1,734,004 | 14\\.7% | 7\\.6% | 13\\.4% |\n| West Virginia | 390,546 | 402,303 | 437,061 | 457,534 | 3\\.0% | 8\\.6% | 13\\.7% |\n| Wisconsin | 756,650 | 766,477 | 910,960 | 995,094 | 1\\.3% | 18\\.9% | 29\\.8% |\n| NOTES: Select time periods for percent change in MCO enrollment growth rates are shown in this table.“NR” – Not Reported. Methodology for reporting enrollment data varies across states: some states report point in time (PIT) counts while other states report monthly averages.AR, NH, NJ, RI, and UT did not report any data for any time periods.Aggregate growth rates were calculated using states that reported in both periods. From March 2019 – March 2020, 32 states reported in both periods. From March 2020 – September 2020, 32 states reported in both periods. From March – March 2021, 29 states reported in both periods.Data for DC in March 2021 were preliminary. Data for TX were preliminary and February 2021, while data for GA and NE were from January 2021 to represent March 2021 as those were the most up-to-date data available.SOURCES: KFF analysis of state Medicaid managed care enrollment reports. |   |   |   |   |   |   |   |\n\n1. Growth rates were calculated using states that reported in both periods. From March 2019 – March 2020, 32 states reported in both periods. From March 2020 – May 2020, 27 states reported in both periods. From March 2020 – September 2020, 32 states reported in both periods. From March – December 2020, 30 states reported in both periods. From March 2020 – March 2021, 29 states reported in both periods. [↩︎](https:\/\/www.kff.org\/covid-19\/growth-in-medicaid-mco-enrollment-during-the-covid-19-pandemic\/#493912ba-5e3a-4694-aa2f-8d6ba7ee9ffd-link)\n2. The Biden Administration originally reopened enrollment in the Federal ACA Marketplace from February 15 to May 15, 2021 but extended this period through August 15, 2021. [↩︎](https:\/\/www.kff.org\/covid-19\/growth-in-medicaid-mco-enrollment-during-the-covid-19-pandemic\/#ea9d6ceb-6924-43c7-87a8-978cc09032f1-link)","meta_canonical":null}

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URL	https://www.kff.org/covid-19/growth-in-medicaid-mco-enrollment-during-the-covid-19-pandemic/
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Meta Title	Growth in Medicaid MCO Enrollment during the COVID-19 Pandemic \| KFF
Meta Description	This data note looks at state Medicaid managed care enrollment data through March 2021 to assess the impact of the COVID-19 pandemic and economic crisis on Medicaid enrollment. Data collected for 29 states show that the rate of Medicaid managed care enrollment growth was 18.8% when comparing managed care enrollment from March 2020 through March 2021. The rate accelerated compared to March 2020 through September 2020 and reversed the trend seen from March 2019 to March 2020 when aggregate growth declined.
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Boilerpipe Text	This data note looks at state Medicaid managed care enrollment data through March 2021 to assess the impact of the COVID-19 pandemic and economic crisis on Medicaid enrollment. Data collected for 29 states show that the rate of Medicaid managed care enrollment growth was 18.8% when comparing managed care enrollment from March 2020 through March 2021 (Figure 1). The rate accelerated compared to March 2020 through September 2020 and reversed the trend seen from March 2019 to March 2020 when aggregate growth declined. Recent trends mirror national enrollment trends that show enrollment growth has been accelerating since the start of the pandemic. Enrollment growth is primarily attributable to the economic downturn as well as the “maintenance of eligibility” (MOE) requirements tied to a 6.2 percentage point increase in the federal match rate (FMAP) authorized by the Families First Coronavirus Response Act (FFCRA) – which prevents states from disenrolling Medicaid beneficiaries if they accept the additional federal funding. Figure 1: MCO Enrollment Growth Rates: March 2019 – March 2021 Why are recent state MCO enrollment data an important indicator? Preliminary national Medicaid and CHIP enrollment data collected by the Centers for Medicare and Medicaid Services (CMS) is lagged and currently available through January 2021 . These data show an increase in Medicaid and CHIP enrollment of 9.3 million or 13.1% from February 2020 through January 2021. Our KFF Medicaid Managed Care Tracker tracks Medicaid enrollment in comprehensive Medicaid managed care organizations (MCOs) for all states that make these data publicly available. These data are updated in our tracker annually with March enrollment data, but given changes related to the pandemic we have updated the tracker more frequently to provide a more current look at enrollment trends. These data are informative as more than two-thirds of beneficiaries nationally receive most or all of their care through risk-based MCOs and almost two-thirds of states that contract with MCOs enroll 75% or more of their Medicaid beneficiaries in MCOs . Children and nonelderly adults are groups more likely to be affected by changes in the economy and are also more likely to be enrolled in Medicaid MCOs . Increased enrollment in MCOs is directly tied to spending without immediate regard to utilization of care. While utilization may be rebounding, it decreased during the pandemic for non-urgent care. However, since states make upfront capitation payments to MCOs to provide access to a range of services, analyzing growth in Medicaid MCO enrollment specifically is valuable beyond signaling broader trends in Medicaid enrollment. What were the trends prior to the pandemic? Data show that prior to the pandemic, there was an aggregate enrollment decline among reporting states. Specifically, among the 32 states reporting data for March 2019 and March 2020 (of the 40 states, including DC, that contract with MCOs), there was an aggregate decline of 1.3% (Table 1). The median change was essentially flat, showing a 0.4% increase, and there were a relatively equal number of states reporting enrollment gains and enrollment declines (17 and 15 respectively). In 2018, these states accounted for over 90% of the total share of enrollment in Medicaid MCOs nationally. What are the more recent trends? Negative growth seen from March 2019 to March 2020 reversed and started to accelerate following the start of the COVID-19 pandemic. Among states that reported data in the respective months, when compared to March 2020, states saw an increase in enrollment growth of 4.1% in May 2020, 11.3% in September 2020, 15.3% in December 2020, and 18.8% in March 2021 with similar median growth rates in each time period (Figure 1). 1 Growth rates from March 2020 to March 2021 across states ranged from 9.7% (Tennessee) to 37.0% (Nevada) (Figure 2). Overall growth in Medicaid enrollment likely reflects both changes in the economy, as people experience income and job loss and become eligible for and enroll in Medicaid coverage, and the FFCRA MOE provisions that require states to ensure continuous coverage for current Medicaid enrollees through the end of the month in which the PHE ends. There is significant variation in MCO enrollment growth across states; however, the variation appears to align with the variation seen in overall Medicaid enrollment growth rates across states. Figure 2: Percent Growth in Medicaid MCO Enrollment: March 2020 – March 2021 Parent firms, firms that own Medicaid MCOs in two or more states, have seen large increases in both enrollment and market share. As of July 2018 (the latest period with national data) six parent firms – UnitedHealth Group, Centene, Anthem, Molina, Aetna, and WellCare – accounted for over 47% of all Medicaid MCO enrollment . In November 2018, Aetna was acquired by CVS and in 2020, WellCare was acquired by Centene. From March 2020 to March 2021, overall Medicaid MCO enrollment increased by around 8.3 million enrollees of which the five parent firms accounted for almost 60% (Figure 3). Figure 3: Five Fortune 500 firms made almost 60% of the increase in MCO enrollment in 28 states from March 2020 – March 2021 What should we watch going forward? Last summer, states projected that the MOE requirements and the continued economic downturn would maintain upward pressure on Medicaid enrollment in FY 2021 (which ends June 30, 2021 for most states). While the current PHE declaration expires 90 days from April 21, 2021, the Biden Administration has notified states that the PHE will likely remain in place throughout CY 2021 and that states will receive 60 days-notice before the end of the PHE. Additionally, with the Biden administration’s executive order to reopen the enrollment in the federal ACA Marketplace and the “no wrong door” application process, more individuals may enroll in Medicaid coverage in the coming months. 2 Enrollment may continue to grow while the MOE remains in place, during ACA open enrollment period that continues through August 15, 2021, and because enrollment growth may be lagged and continue even as national indicators begin to improve. This effect was observed following the end of the Great Recession in 2009 when Medicaid spending and enrollment continued to grow in 2010 and 2011. Continued growth in MCO enrollment could put pressure on overall state budgets. Therefore, states may want to continue to review utilization patterns as well as options to mitigate risks related to potential overpayments to MCOs. Table 1: Change in MCO Enrollment, March 2019 – March 2021 Enrollment Percent Change State March 2019 March 2020 September 2020 March 2021 March 2019 – March 2020 March 2020 – September 2020 March 2020 – March 2021 Overall 33 States Reporting 33 States Reporting 34 States Reporting 29 States Reporting -1.3% 11.3% 18.8% Arizona 1,514,431 1,517,228 1,692,948 1,800,529 0.2% 11.6% 18.7% California 10,452,386 10,166,418 10,857,552 11,353,379 -2.7% 6.8% 11.7% Colorado 110,965 121,435 138,312 151,270 9.4% 13.9% 24.6% Delaware 200,194 198,477 213,216 NR -0.9% 7.4% – District of Columbia 194,896 182,530 200,049 225,989 -6.3% 9.6% 23.8% Florida 2,975,428 2,906,434 3,389,302 3,677,298 -2.3% 16.6% 26.5% Georgia 1,360,907 1,387,641 1,607,743 1,696,673 2.0% 15.9% 22.3% Hawaii 344,254 340,541 378,100 407,422 -1.1% 11.0% 19.6% Illinois 2,144,696 2,197,501 2,549,635 2,691,162 2.5% 16.0% 22.5% Indiana 1,078,209 1,116,114 1,307,448 1,458,069 3.5% 17.1% 30.6% Iowa 562,432 578,226 635,790 675,185 2.8% 10.0% 16.8% Kansas 380,022 389,754 419,109 440,681 2.6% 7.5% 13.1% Kentucky 1,233,360 1,195,787 1,305,929 1,500,939 -3.0% 9.2% 25.5% Louisiana 1,533,075 NR 1,611,537 1,706,781 – – – Maryland 1,197,185 1,212,628 1,294,436 1,364,957 1.3% 6.7% 12.6% Massachusetts 695,290 717,029 787,379 NR 3.1% 9.8% – Michigan 1,760,122 1,772,762 1,975,341 2,105,078 0.7% 11.4% 18.7% Minnesota 835,528 841,347 967,376 1,033,751 0.7% 15.0% 22.9% Mississippi 437,194 431,523 462,070 485,435 -1.3% 7.1% 12.5% Missouri 676,539 549,116 680,421 744,224 -18.8% 23.9% 35.5% Nebraska 233,431 232,991 257,589 295,175 -0.2% 10.6% 26.7% Nevada 466,227 434,252 543,650 595,001 -6.9% 25.2% 37.0% New Mexico 660,646 674,343 727,421 762,714 2.1% 7.9% 13.1% New York 4,344,939 4,210,483 4,776,592 5,054,373 -3.1% 13.4% 20.0% North Dakota NR 19,814 22,593 NR – 14.0% – Ohio 2,344,075 2,055,454 NR NR -12.3% – – Oregon 853,185 898,749 994,631 1,068,563 5.3% 10.7% 18.9% Pennsylvania 2,274,092 2,235,532 2,461,326 2,626,383 -1.7% 10.1% 17.5% South Carolina 794,184 788,253 872,574 934,517 -0.7% 10.7% 18.6% Tennessee 1,389,600 1,421,145 1,493,081 1,558,446 2.3% 5.1% 9.7% Texas 3,688,147 3,614,486 4,126,940 4,504,285 -2.0% 14.2% 24.6% Virginia NR NR 1,513,132 1,634,786 – – – Washington 1,332,557 1,529,039 1,645,684 1,734,004 14.7% 7.6% 13.4% West Virginia 390,546 402,303 437,061 457,534 3.0% 8.6% 13.7% Wisconsin 756,650 766,477 910,960 995,094 1.3% 18.9% 29.8% NOTES: Select time periods for percent change in MCO enrollment growth rates are shown in this table.“NR” – Not Reported. Methodology for reporting enrollment data varies across states: some states report point in time (PIT) counts while other states report monthly averages.AR, NH, NJ, RI, and UT did not report any data for any time periods.Aggregate growth rates were calculated using states that reported in both periods. From March 2019 – March 2020, 32 states reported in both periods. From March 2020 – September 2020, 32 states reported in both periods. From March – March 2021, 29 states reported in both periods.Data for DC in March 2021 were preliminary. Data for TX were preliminary and February 2021, while data for GA and NE were from January 2021 to represent March 2021 as those were the most up-to-date data available.SOURCES: KFF analysis of state Medicaid managed care enrollment reports. Growth rates were calculated using states that reported in both periods. From March 2019 – March 2020, 32 states reported in both periods. From March 2020 – May 2020, 27 states reported in both periods. From March 2020 – September 2020, 32 states reported in both periods. From March – December 2020, 30 states reported in both periods. From March 2020 – March 2021, 29 states reported in both periods. ↩︎ The Biden Administration originally reopened enrollment in the Federal ACA Marketplace from February 15 to May 15, 2021 but extended this period through August 15, 2021. ↩︎
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Data collected for 29 states show that the rate of Medicaid managed care enrollment growth was 18.8% when comparing managed care enrollment from March 2020 through March 2021 (Figure 1). The rate accelerated compared to March 2020 through September 2020 and reversed the trend seen from March 2019 to March 2020 when aggregate growth declined. Recent trends mirror [national enrollment trends](https://www.kff.org/coronavirus-covid-19/issue-brief/analysis-of-recent-national-trends-in-medicaid-and-chip-enrollment/) that show enrollment growth has been accelerating since the start of the pandemic. Enrollment growth is primarily attributable to the economic downturn as well as the [“maintenance of eligibility” (MOE) requirements](https://www.kff.org/medicaid/issue-brief/medicaid-maintenance-of-eligibility-requirements-issues-to-watch-when-they-end/) tied to a 6.2 percentage point increase in the federal match rate (FMAP) authorized by the Families First Coronavirus Response Act (FFCRA) – which prevents states from disenrolling Medicaid beneficiaries if they accept the additional federal funding. ![](https://www.kff.org/wp-content/uploads/sites/7/2021/06/9500-04-Figure-1-1.png?w=1024) Figure 1: MCO Enrollment Growth Rates: March 2019 – March 2021 Why are recent state MCO enrollment data an important indicator? Preliminary national Medicaid and CHIP enrollment data collected by the Centers for Medicare and Medicaid Services (CMS) is lagged and currently available through [January 2021](https://www.kff.org/coronavirus-covid-19/issue-brief/analysis-of-recent-national-trends-in-medicaid-and-chip-enrollment/). These data show an increase in Medicaid and CHIP enrollment of 9.3 million or 13.1% from February 2020 through January 2021. Our [KFF Medicaid Managed Care Tracker](https://www.kff.org/data-collection/medicaid-managed-care-market-tracker/) tracks Medicaid enrollment in comprehensive Medicaid managed care organizations (MCOs) for all states that make these data publicly available. These data are updated in our tracker annually with March enrollment data, but given changes related to the pandemic we have updated the tracker more frequently to provide a more current look at enrollment trends. These data are informative as [more than two-thirds](https://www.kff.org/other/state-indicator/total-medicaid-mco-enrollment/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D) of beneficiaries nationally receive most or all of their care through risk-based MCOs and almost two-thirds of states that contract with MCOs [enroll 75% or more of their Medicaid beneficiaries in MCOs](https://www.kff.org/other/state-indicator/total-medicaid-mco-enrollment/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D). Children and nonelderly adults are groups more likely to be affected by changes in the economy and [are also more likely to be enrolled in Medicaid MCOs](https://www.kff.org/medicaid/state-indicator/managed-care-penetration-rates-by-eligibility-group/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D). Increased enrollment in MCOs is directly tied to spending without immediate regard to utilization of care. While utilization may be rebounding, it [decreased](https://www.healthsystemtracker.org/chart-collection/how-have-healthcare-utilization-and-spending-changed-so-far-during-the-coronavirus-pandemic/#item-covidcostsuse_marchupdate_7) during the pandemic for non-urgent care. However, since states make upfront capitation payments to MCOs to provide access to a range of services, analyzing growth in Medicaid MCO enrollment specifically is valuable beyond signaling broader trends in Medicaid enrollment. What were the trends prior to the pandemic? Data show that prior to the pandemic, there was an aggregate enrollment decline among reporting states. Specifically, among the 32 states reporting data for March 2019 and March 2020 (of the 40 states, including DC, that contract with MCOs), there was an aggregate decline of 1.3% (Table 1). The median change was essentially flat, showing a 0.4% increase, and there were a relatively equal number of states reporting enrollment gains and enrollment declines (17 and 15 respectively). In 2018, these states accounted for [over 90% of the total share](https://www.medicaid.gov/medicaid/managed-care/downloads/2018-medicaid-managed-care-enrollment-report.pdf) of enrollment in Medicaid MCOs nationally. What are the more recent trends? Negative growth seen from March 2019 to March 2020 reversed and started to accelerate following the start of the COVID-19 pandemic. Among states that reported data in the respective months, when compared to March 2020, states saw an increase in enrollment growth of 4.1% in May 2020, 11.3% in September 2020, 15.3% in December 2020, and 18.8% in March 2021 with similar median growth rates in each time period (Figure 1).[1](https://www.kff.org/covid-19/growth-in-medicaid-mco-enrollment-during-the-covid-19-pandemic/#493912ba-5e3a-4694-aa2f-8d6ba7ee9ffd) Growth rates from March 2020 to March 2021 across states ranged from 9.7% (Tennessee) to 37.0% (Nevada) (Figure 2). Overall growth in Medicaid enrollment likely reflects both changes in the economy, as people experience income and job loss and become eligible for and enroll in Medicaid coverage, and the FFCRA MOE provisions that require states to ensure continuous coverage for current Medicaid enrollees through the end of the month in which the PHE ends. There is significant variation in MCO enrollment growth across states; however, the variation appears to align with the variation seen in overall Medicaid enrollment growth rates across states. ![](https://www.kff.org/wp-content/uploads/sites/7/2021/06/9500-04-Figure-2-1.png?w=1024) Figure 2: Percent Growth in Medicaid MCO Enrollment: March 2020 – March 2021 Parent firms, firms that own Medicaid MCOs in two or more states, have seen large increases in both enrollment and market share. As of July 2018 (the latest period with national data) six parent firms – UnitedHealth Group, Centene, Anthem, Molina, Aetna, and WellCare – [accounted for over 47% of all Medicaid MCO enrollment](https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid-managed-care/). In November 2018, Aetna was acquired by CVS and in 2020, WellCare was acquired by Centene. From March 2020 to March 2021, overall Medicaid MCO enrollment increased by around 8.3 million enrollees of which the five parent firms accounted for almost 60% (Figure 3). ![](https://www.kff.org/wp-content/uploads/sites/7/2021/06/9500-04-Figure-3.png?w=1024) Figure 3: Five Fortune 500 firms made almost 60% of the increase in MCO enrollment in 28 states from March 2020 – March 2021 What should we watch going forward? Last summer, states projected that the MOE requirements and the continued economic downturn would maintain upward pressure on Medicaid enrollment in [FY 2021](https://www.kff.org/medicaid/issue-brief/medicaid-enrollment-spending-growth-fy-2020-2021/) (which ends June 30, 2021 for most states). While the current PHE declaration [expires](https://www.phe.gov/emergency/news/healthactions/phe/Pages/COVID-15April2021.aspx) 90 days from April 21, 2021, the Biden Administration has notified states that the PHE will likely remain in place throughout CY 2021 and that states will receive 60 days-notice before the end of the PHE. Additionally, with the Biden administration’s executive order to reopen the enrollment in the federal ACA Marketplace and the “no wrong door” application process, [more individuals may enroll in Medicaid coverage](https://www.kff.org/policy-watch/aca-open-enrollment-matters-for-medicaid-coverage-too/) in the coming months.[2](https://www.kff.org/covid-19/growth-in-medicaid-mco-enrollment-during-the-covid-19-pandemic/#ea9d6ceb-6924-43c7-87a8-978cc09032f1) Enrollment may continue to grow while the MOE remains in place, during ACA open enrollment period that continues through August 15, 2021, and because [enrollment growth may be lagged](https://www.healthaffairs.org/do/10.1377/hblog20200806.165269/full/) and continue even as national indicators begin to improve. This effect was observed following the end of the Great Recession in 2009 when Medicaid [spending and enrollment](https://www.kff.org/medicaid/issue-brief/medicaid-enrollment-spending-growth-fy-2020-2021/#:~:text=Across%20all%20reporting%20states%2C%20states,expenditure%20growth%20in%20FY%202021.) continued to grow in 2010 and 2011. Continued growth in MCO enrollment could put pressure on overall state budgets. Therefore, states may want to continue to review utilization patterns as well as options to mitigate risks related to potential overpayments to MCOs. \| \| \| \| \| \| \| \| \| \|---\|---\|---\|---\|---\|---\|---\|---\| \| Table 1: Change in MCO Enrollment, March 2019 – March 2021 \| \| \| \| \| \| \| \| \| \| Enrollment \| Percent Change \| \| \| \| \| \| \| State \| March 2019 \| March 2020 \| September 2020 \| March 2021 \| March 2019 – March 2020 \| March 2020 – September 2020 \| March 2020 – March 2021** \| \| Overall \| 33 States Reporting \| 33 States Reporting \| 34 States Reporting \| 29 States Reporting \| \-1.3% \| 11\.3% \| 18\.8% \| \| Arizona \| 1,514,431 \| 1,517,228 \| 1,692,948 \| 1,800,529 \| 0\.2% \| 11\.6% \| 18\.7% \| \| California \| 10,452,386 \| 10,166,418 \| 10,857,552 \| 11,353,379 \| \-2.7% \| 6\.8% \| 11\.7% \| \| Colorado \| 110,965 \| 121,435 \| 138,312 \| 151,270 \| 9\.4% \| 13\.9% \| 24\.6% \| \| Delaware \| 200,194 \| 198,477 \| 213,216 \| NR \| \-0.9% \| 7\.4% \| – \| \| District of Columbia \| 194,896 \| 182,530 \| 200,049 \| 225,989 \| \-6.3% \| 9\.6% \| 23\.8% \| \| Florida \| 2,975,428 \| 2,906,434 \| 3,389,302 \| 3,677,298 \| \-2.3% \| 16\.6% \| 26\.5% \| \| Georgia \| 1,360,907 \| 1,387,641 \| 1,607,743 \| 1,696,673 \| 2\.0% \| 15\.9% \| 22\.3% \| \| Hawaii \| 344,254 \| 340,541 \| 378,100 \| 407,422 \| \-1.1% \| 11\.0% \| 19\.6% \| \| Illinois \| 2,144,696 \| 2,197,501 \| 2,549,635 \| 2,691,162 \| 2\.5% \| 16\.0% \| 22\.5% \| \| Indiana \| 1,078,209 \| 1,116,114 \| 1,307,448 \| 1,458,069 \| 3\.5% \| 17\.1% \| 30\.6% \| \| Iowa \| 562,432 \| 578,226 \| 635,790 \| 675,185 \| 2\.8% \| 10\.0% \| 16\.8% \| \| Kansas \| 380,022 \| 389,754 \| 419,109 \| 440,681 \| 2\.6% \| 7\.5% \| 13\.1% \| \| Kentucky \| 1,233,360 \| 1,195,787 \| 1,305,929 \| 1,500,939 \| \-3.0% \| 9\.2% \| 25\.5% \| \| Louisiana \| 1,533,075 \| NR \| 1,611,537 \| 1,706,781 \| – \| – \| – \| \| Maryland \| 1,197,185 \| 1,212,628 \| 1,294,436 \| 1,364,957 \| 1\.3% \| 6\.7% \| 12\.6% \| \| Massachusetts \| 695,290 \| 717,029 \| 787,379 \| NR \| 3\.1% \| 9\.8% \| – \| \| Michigan \| 1,760,122 \| 1,772,762 \| 1,975,341 \| 2,105,078 \| 0\.7% \| 11\.4% \| 18\.7% \| \| Minnesota \| 835,528 \| 841,347 \| 967,376 \| 1,033,751 \| 0\.7% \| 15\.0% \| 22\.9% \| \| Mississippi \| 437,194 \| 431,523 \| 462,070 \| 485,435 \| \-1.3% \| 7\.1% \| 12\.5% \| \| Missouri \| 676,539 \| 549,116 \| 680,421 \| 744,224 \| \-18.8% \| 23\.9% \| 35\.5% \| \| Nebraska \| 233,431 \| 232,991 \| 257,589 \| 295,175 \| \-0.2% \| 10\.6% \| 26\.7% \| \| Nevada \| 466,227 \| 434,252 \| 543,650 \| 595,001 \| \-6.9% \| 25\.2% \| 37\.0% \| \| New Mexico \| 660,646 \| 674,343 \| 727,421 \| 762,714 \| 2\.1% \| 7\.9% \| 13\.1% \| \| New York \| 4,344,939 \| 4,210,483 \| 4,776,592 \| 5,054,373 \| \-3.1% \| 13\.4% \| 20\.0% \| \| North Dakota \| NR \| 19,814 \| 22,593 \| NR \| – \| 14\.0% \| – \| \| Ohio \| 2,344,075 \| 2,055,454 \| NR \| NR \| \-12.3% \| – \| – \| \| Oregon \| 853,185 \| 898,749 \| 994,631 \| 1,068,563 \| 5\.3% \| 10\.7% \| 18\.9% \| \| Pennsylvania \| 2,274,092 \| 2,235,532 \| 2,461,326 \| 2,626,383 \| \-1.7% \| 10\.1% \| 17\.5% \| \| South Carolina \| 794,184 \| 788,253 \| 872,574 \| 934,517 \| \-0.7% \| 10\.7% \| 18\.6% \| \| Tennessee \| 1,389,600 \| 1,421,145 \| 1,493,081 \| 1,558,446 \| 2\.3% \| 5\.1% \| 9\.7% \| \| Texas \| 3,688,147 \| 3,614,486 \| 4,126,940 \| 4,504,285 \| \-2.0% \| 14\.2% \| 24\.6% \| \| Virginia \| NR \| NR \| 1,513,132 \| 1,634,786 \| – \| – \| – \| \| Washington \| 1,332,557 \| 1,529,039 \| 1,645,684 \| 1,734,004 \| 14\.7% \| 7\.6% \| 13\.4% \| \| West Virginia \| 390,546 \| 402,303 \| 437,061 \| 457,534 \| 3\.0% \| 8\.6% \| 13\.7% \| \| Wisconsin \| 756,650 \| 766,477 \| 910,960 \| 995,094 \| 1\.3% \| 18\.9% \| 29\.8% \| \| NOTES: Select time periods for percent change in MCO enrollment growth rates are shown in this table.“NR” – Not Reported. Methodology for reporting enrollment data varies across states: some states report point in time (PIT) counts while other states report monthly averages.AR, NH, NJ, RI, and UT did not report any data for any time periods.Aggregate growth rates were calculated using states that reported in both periods. From March 2019 – March 2020, 32 states reported in both periods. From March 2020 – September 2020, 32 states reported in both periods. From March – March 2021, 29 states reported in both periods.Data for DC in March 2021 were preliminary. Data for TX were preliminary and February 2021, while data for GA and NE were from January 2021 to represent March 2021 as those were the most up-to-date data available.SOURCES: KFF analysis of state Medicaid managed care enrollment reports. \| \| \| \| \| \| \| \| 1. Growth rates were calculated using states that reported in both periods. From March 2019 – March 2020, 32 states reported in both periods. From March 2020 – May 2020, 27 states reported in both periods. From March 2020 – September 2020, 32 states reported in both periods. From March – December 2020, 30 states reported in both periods. From March 2020 – March 2021, 29 states reported in both periods. [↩︎](https://www.kff.org/covid-19/growth-in-medicaid-mco-enrollment-during-the-covid-19-pandemic/#493912ba-5e3a-4694-aa2f-8d6ba7ee9ffd-link) 2. The Biden Administration originally reopened enrollment in the Federal ACA Marketplace from February 15 to May 15, 2021 but extended this period through August 15, 2021. [↩︎](https://www.kff.org/covid-19/growth-in-medicaid-mco-enrollment-during-the-covid-19-pandemic/#ea9d6ceb-6924-43c7-87a8-978cc09032f1-link) More On [COVID-19](https://www.kff.org/topic/covid-19/) [Medicaid](https://www.kff.org/topic/medicaid/) [Enrollment](https://www.kff.org/tag/enrollment/) [Managed Care](https://www.kff.org/tag/managed-care/) ## Also of Interest ### [Medicaid Managed Care Reporting and Transparency: Managed Care Program Annual Reports](https://www.kff.org/medicaid/medicaid-managed-care-reporting-and-transparency-managed-care-program-annual-reports/) ### [10 Things to Know About Medicaid Managed Care](https://www.kff.org/medicaid/10-things-to-know-about-medicaid-managed-care/) ### [A Look at Medicaid Enrollment and Finances of the Five Largest Medicaid Managed Care Plans](https://www.kff.org/medicaid/a-look-at-medicaid-enrollment-and-finances-of-the-five-largest-medicaid-managed-care-plans/) ## More On - [COVID-19](https://www.kff.org/topic/covid-19/) - [Medicaid](https://www.kff.org/topic/medicaid/) - [Enrollment](https://www.kff.org/tag/enrollment/) - [Managed Care](https://www.kff.org/tag/managed-care/) [View all Topics](https://www.kff.org/topics/) - [Policy Research](https://www.kff.org/policy-research/) - [Polling](https://www.kff.org/topic/public-opinion) - [Health News](https://www.kffhealthnews.org/) About Us - [Conference Centers](https://www.kff.org/about-us/conference-centers/) - [Join Our Team](https://www.kff.org/about-us/employment-opportunities/) - [Contact Us](https://www.kff.org/about-us/contact-us/) - [Follow Us](https://www.kff.org/about-us/follow-us/) ### Sign up for emails Join our email list for regular updates based on your personal preferences. 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Readable Markdown	This data note looks at state Medicaid managed care enrollment data through March 2021 to assess the impact of the COVID-19 pandemic and economic crisis on Medicaid enrollment. Data collected for 29 states show that the rate of Medicaid managed care enrollment growth was 18.8% when comparing managed care enrollment from March 2020 through March 2021 (Figure 1). The rate accelerated compared to March 2020 through September 2020 and reversed the trend seen from March 2019 to March 2020 when aggregate growth declined. Recent trends mirror [national enrollment trends](https://www.kff.org/coronavirus-covid-19/issue-brief/analysis-of-recent-national-trends-in-medicaid-and-chip-enrollment/) that show enrollment growth has been accelerating since the start of the pandemic. Enrollment growth is primarily attributable to the economic downturn as well as the [“maintenance of eligibility” (MOE) requirements](https://www.kff.org/medicaid/issue-brief/medicaid-maintenance-of-eligibility-requirements-issues-to-watch-when-they-end/) tied to a 6.2 percentage point increase in the federal match rate (FMAP) authorized by the Families First Coronavirus Response Act (FFCRA) – which prevents states from disenrolling Medicaid beneficiaries if they accept the additional federal funding. ![](https://www.kff.org/wp-content/uploads/sites/7/2021/06/9500-04-Figure-1-1.png?w=1024) Figure 1: MCO Enrollment Growth Rates: March 2019 – March 2021 Why are recent state MCO enrollment data an important indicator? Preliminary national Medicaid and CHIP enrollment data collected by the Centers for Medicare and Medicaid Services (CMS) is lagged and currently available through [January 2021](https://www.kff.org/coronavirus-covid-19/issue-brief/analysis-of-recent-national-trends-in-medicaid-and-chip-enrollment/). These data show an increase in Medicaid and CHIP enrollment of 9.3 million or 13.1% from February 2020 through January 2021. Our [KFF Medicaid Managed Care Tracker](https://www.kff.org/data-collection/medicaid-managed-care-market-tracker/) tracks Medicaid enrollment in comprehensive Medicaid managed care organizations (MCOs) for all states that make these data publicly available. These data are updated in our tracker annually with March enrollment data, but given changes related to the pandemic we have updated the tracker more frequently to provide a more current look at enrollment trends. These data are informative as [more than two-thirds](https://www.kff.org/other/state-indicator/total-medicaid-mco-enrollment/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D) of beneficiaries nationally receive most or all of their care through risk-based MCOs and almost two-thirds of states that contract with MCOs [enroll 75% or more of their Medicaid beneficiaries in MCOs](https://www.kff.org/other/state-indicator/total-medicaid-mco-enrollment/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D). Children and nonelderly adults are groups more likely to be affected by changes in the economy and [are also more likely to be enrolled in Medicaid MCOs](https://www.kff.org/medicaid/state-indicator/managed-care-penetration-rates-by-eligibility-group/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D). Increased enrollment in MCOs is directly tied to spending without immediate regard to utilization of care. While utilization may be rebounding, it [decreased](https://www.healthsystemtracker.org/chart-collection/how-have-healthcare-utilization-and-spending-changed-so-far-during-the-coronavirus-pandemic/#item-covidcostsuse_marchupdate_7) during the pandemic for non-urgent care. However, since states make upfront capitation payments to MCOs to provide access to a range of services, analyzing growth in Medicaid MCO enrollment specifically is valuable beyond signaling broader trends in Medicaid enrollment. What were the trends prior to the pandemic? Data show that prior to the pandemic, there was an aggregate enrollment decline among reporting states. Specifically, among the 32 states reporting data for March 2019 and March 2020 (of the 40 states, including DC, that contract with MCOs), there was an aggregate decline of 1.3% (Table 1). The median change was essentially flat, showing a 0.4% increase, and there were a relatively equal number of states reporting enrollment gains and enrollment declines (17 and 15 respectively). In 2018, these states accounted for [over 90% of the total share](https://www.medicaid.gov/medicaid/managed-care/downloads/2018-medicaid-managed-care-enrollment-report.pdf) of enrollment in Medicaid MCOs nationally. What are the more recent trends? Negative growth seen from March 2019 to March 2020 reversed and started to accelerate following the start of the COVID-19 pandemic. Among states that reported data in the respective months, when compared to March 2020, states saw an increase in enrollment growth of 4.1% in May 2020, 11.3% in September 2020, 15.3% in December 2020, and 18.8% in March 2021 with similar median growth rates in each time period (Figure 1).[1](https://www.kff.org/covid-19/growth-in-medicaid-mco-enrollment-during-the-covid-19-pandemic/#493912ba-5e3a-4694-aa2f-8d6ba7ee9ffd) Growth rates from March 2020 to March 2021 across states ranged from 9.7% (Tennessee) to 37.0% (Nevada) (Figure 2). Overall growth in Medicaid enrollment likely reflects both changes in the economy, as people experience income and job loss and become eligible for and enroll in Medicaid coverage, and the FFCRA MOE provisions that require states to ensure continuous coverage for current Medicaid enrollees through the end of the month in which the PHE ends. There is significant variation in MCO enrollment growth across states; however, the variation appears to align with the variation seen in overall Medicaid enrollment growth rates across states. ![](https://www.kff.org/wp-content/uploads/sites/7/2021/06/9500-04-Figure-2-1.png?w=1024) Figure 2: Percent Growth in Medicaid MCO Enrollment: March 2020 – March 2021 Parent firms, firms that own Medicaid MCOs in two or more states, have seen large increases in both enrollment and market share. As of July 2018 (the latest period with national data) six parent firms – UnitedHealth Group, Centene, Anthem, Molina, Aetna, and WellCare – [accounted for over 47% of all Medicaid MCO enrollment](https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid-managed-care/). In November 2018, Aetna was acquired by CVS and in 2020, WellCare was acquired by Centene. From March 2020 to March 2021, overall Medicaid MCO enrollment increased by around 8.3 million enrollees of which the five parent firms accounted for almost 60% (Figure 3). ![](https://www.kff.org/wp-content/uploads/sites/7/2021/06/9500-04-Figure-3.png?w=1024) Figure 3: Five Fortune 500 firms made almost 60% of the increase in MCO enrollment in 28 states from March 2020 – March 2021 What should we watch going forward? Last summer, states projected that the MOE requirements and the continued economic downturn would maintain upward pressure on Medicaid enrollment in [FY 2021](https://www.kff.org/medicaid/issue-brief/medicaid-enrollment-spending-growth-fy-2020-2021/) (which ends June 30, 2021 for most states). While the current PHE declaration [expires](https://www.phe.gov/emergency/news/healthactions/phe/Pages/COVID-15April2021.aspx) 90 days from April 21, 2021, the Biden Administration has notified states that the PHE will likely remain in place throughout CY 2021 and that states will receive 60 days-notice before the end of the PHE. Additionally, with the Biden administration’s executive order to reopen the enrollment in the federal ACA Marketplace and the “no wrong door” application process, [more individuals may enroll in Medicaid coverage](https://www.kff.org/policy-watch/aca-open-enrollment-matters-for-medicaid-coverage-too/) in the coming months.[2](https://www.kff.org/covid-19/growth-in-medicaid-mco-enrollment-during-the-covid-19-pandemic/#ea9d6ceb-6924-43c7-87a8-978cc09032f1) Enrollment may continue to grow while the MOE remains in place, during ACA open enrollment period that continues through August 15, 2021, and because [enrollment growth may be lagged](https://www.healthaffairs.org/do/10.1377/hblog20200806.165269/full/) and continue even as national indicators begin to improve. This effect was observed following the end of the Great Recession in 2009 when Medicaid [spending and enrollment](https://www.kff.org/medicaid/issue-brief/medicaid-enrollment-spending-growth-fy-2020-2021/#:~:text=Across%20all%20reporting%20states%2C%20states,expenditure%20growth%20in%20FY%202021.) continued to grow in 2010 and 2011. Continued growth in MCO enrollment could put pressure on overall state budgets. Therefore, states may want to continue to review utilization patterns as well as options to mitigate risks related to potential overpayments to MCOs. \| \| \| \| \| \| \| \| \| \|---\|---\|---\|---\|---\|---\|---\|---\| \| Table 1: Change in MCO Enrollment, March 2019 – March 2021 \| \| \| \| \| \| \| \| \| \| Enrollment \| Percent Change \| \| \| \| \| \| \| State \| March 2019 \| March 2020 \| September 2020 \| March 2021 \| March 2019 – March 2020 \| March 2020 – September 2020 \| March 2020 – March 2021 \| \| Overall \| 33 States Reporting \| 33 States Reporting \| 34 States Reporting \| 29 States Reporting \| \-1.3% \| 11\.3% \| 18\.8% \| \| Arizona \| 1,514,431 \| 1,517,228 \| 1,692,948 \| 1,800,529 \| 0\.2% \| 11\.6% \| 18\.7% \| \| California \| 10,452,386 \| 10,166,418 \| 10,857,552 \| 11,353,379 \| \-2.7% \| 6\.8% \| 11\.7% \| \| Colorado \| 110,965 \| 121,435 \| 138,312 \| 151,270 \| 9\.4% \| 13\.9% \| 24\.6% \| \| Delaware \| 200,194 \| 198,477 \| 213,216 \| NR \| \-0.9% \| 7\.4% \| – \| \| District of Columbia \| 194,896 \| 182,530 \| 200,049 \| 225,989 \| \-6.3% \| 9\.6% \| 23\.8% \| \| Florida \| 2,975,428 \| 2,906,434 \| 3,389,302 \| 3,677,298 \| \-2.3% \| 16\.6% \| 26\.5% \| \| Georgia \| 1,360,907 \| 1,387,641 \| 1,607,743 \| 1,696,673 \| 2\.0% \| 15\.9% \| 22\.3% \| \| Hawaii \| 344,254 \| 340,541 \| 378,100 \| 407,422 \| \-1.1% \| 11\.0% \| 19\.6% \| \| Illinois \| 2,144,696 \| 2,197,501 \| 2,549,635 \| 2,691,162 \| 2\.5% \| 16\.0% \| 22\.5% \| \| Indiana \| 1,078,209 \| 1,116,114 \| 1,307,448 \| 1,458,069 \| 3\.5% \| 17\.1% \| 30\.6% \| \| Iowa \| 562,432 \| 578,226 \| 635,790 \| 675,185 \| 2\.8% \| 10\.0% \| 16\.8% \| \| Kansas \| 380,022 \| 389,754 \| 419,109 \| 440,681 \| 2\.6% \| 7\.5% \| 13\.1% \| \| Kentucky \| 1,233,360 \| 1,195,787 \| 1,305,929 \| 1,500,939 \| \-3.0% \| 9\.2% \| 25\.5% \| \| Louisiana \| 1,533,075 \| NR \| 1,611,537 \| 1,706,781 \| – \| – \| – \| \| Maryland \| 1,197,185 \| 1,212,628 \| 1,294,436 \| 1,364,957 \| 1\.3% \| 6\.7% \| 12\.6% \| \| Massachusetts \| 695,290 \| 717,029 \| 787,379 \| NR \| 3\.1% \| 9\.8% \| – \| \| Michigan \| 1,760,122 \| 1,772,762 \| 1,975,341 \| 2,105,078 \| 0\.7% \| 11\.4% \| 18\.7% \| \| Minnesota \| 835,528 \| 841,347 \| 967,376 \| 1,033,751 \| 0\.7% \| 15\.0% \| 22\.9% \| \| Mississippi \| 437,194 \| 431,523 \| 462,070 \| 485,435 \| \-1.3% \| 7\.1% \| 12\.5% \| \| Missouri \| 676,539 \| 549,116 \| 680,421 \| 744,224 \| \-18.8% \| 23\.9% \| 35\.5% \| \| Nebraska \| 233,431 \| 232,991 \| 257,589 \| 295,175 \| \-0.2% \| 10\.6% \| 26\.7% \| \| Nevada \| 466,227 \| 434,252 \| 543,650 \| 595,001 \| \-6.9% \| 25\.2% \| 37\.0% \| \| New Mexico \| 660,646 \| 674,343 \| 727,421 \| 762,714 \| 2\.1% \| 7\.9% \| 13\.1% \| \| New York \| 4,344,939 \| 4,210,483 \| 4,776,592 \| 5,054,373 \| \-3.1% \| 13\.4% \| 20\.0% \| \| North Dakota \| NR \| 19,814 \| 22,593 \| NR \| – \| 14\.0% \| – \| \| Ohio \| 2,344,075 \| 2,055,454 \| NR \| NR \| \-12.3% \| – \| – \| \| Oregon \| 853,185 \| 898,749 \| 994,631 \| 1,068,563 \| 5\.3% \| 10\.7% \| 18\.9% \| \| Pennsylvania \| 2,274,092 \| 2,235,532 \| 2,461,326 \| 2,626,383 \| \-1.7% \| 10\.1% \| 17\.5% \| \| South Carolina \| 794,184 \| 788,253 \| 872,574 \| 934,517 \| \-0.7% \| 10\.7% \| 18\.6% \| \| Tennessee \| 1,389,600 \| 1,421,145 \| 1,493,081 \| 1,558,446 \| 2\.3% \| 5\.1% \| 9\.7% \| \| Texas \| 3,688,147 \| 3,614,486 \| 4,126,940 \| 4,504,285 \| \-2.0% \| 14\.2% \| 24\.6% \| \| Virginia \| NR \| NR \| 1,513,132 \| 1,634,786 \| – \| – \| – \| \| Washington \| 1,332,557 \| 1,529,039 \| 1,645,684 \| 1,734,004 \| 14\.7% \| 7\.6% \| 13\.4% \| \| West Virginia \| 390,546 \| 402,303 \| 437,061 \| 457,534 \| 3\.0% \| 8\.6% \| 13\.7% \| \| Wisconsin \| 756,650 \| 766,477 \| 910,960 \| 995,094 \| 1\.3% \| 18\.9% \| 29\.8% \| \| NOTES: Select time periods for percent change in MCO enrollment growth rates are shown in this table.“NR” – Not Reported. Methodology for reporting enrollment data varies across states: some states report point in time (PIT) counts while other states report monthly averages.AR, NH, NJ, RI, and UT did not report any data for any time periods.Aggregate growth rates were calculated using states that reported in both periods. From March 2019 – March 2020, 32 states reported in both periods. From March 2020 – September 2020, 32 states reported in both periods. From March – March 2021, 29 states reported in both periods.Data for DC in March 2021 were preliminary. Data for TX were preliminary and February 2021, while data for GA and NE were from January 2021 to represent March 2021 as those were the most up-to-date data available.SOURCES: KFF analysis of state Medicaid managed care enrollment reports. \| \| \| \| \| \| \| \| 1. Growth rates were calculated using states that reported in both periods. From March 2019 – March 2020, 32 states reported in both periods. From March 2020 – May 2020, 27 states reported in both periods. From March 2020 – September 2020, 32 states reported in both periods. From March – December 2020, 30 states reported in both periods. From March 2020 – March 2021, 29 states reported in both periods. [↩︎](https://www.kff.org/covid-19/growth-in-medicaid-mco-enrollment-during-the-covid-19-pandemic/#493912ba-5e3a-4694-aa2f-8d6ba7ee9ffd-link) 2. The Biden Administration originally reopened enrollment in the Federal ACA Marketplace from February 15 to May 15, 2021 but extended this period through August 15, 2021. [↩︎](https://www.kff.org/covid-19/growth-in-medicaid-mco-enrollment-during-the-covid-19-pandemic/#ea9d6ceb-6924-43c7-87a8-978cc09032f1-link)
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