January 2025 Update: Missouri Medicaid enrollment steady since unwinding.
Enrollment growing in the Adult Expansion Group, offsetting drops in other categories. Expansion enrollment nears high mark.
February 23, 2025 (updates based on Janaury 2025 state administrative data).
Total net enrollment in Missouri’s Medicaid program has remained relatively steady at about 1.27 million in the last seven months, since the so-called “unwinding” from the Public Health Emergency (PHE) ended May 2024. However, since the end of the unwinding there has been significant drops in enrollment in several categories — especially children, custodial parents, and the disabled — but these drops have been offset by increases in enrollment in the Adult Expansion Group (AEG), which at nearly 350,000 is nearing the high point of 354,000.
These findings are based on analysis by CAHSPER at Washington University in St. Louis of state of Missouri Family Support Division data, posted on their website.
Factors affecting enrollment. The recent changes in enrollment may reflect changes in the process of reverifying enrollment (a regular process done annually), as well as normal growth in Medicaid over time due to population growth. During the Public Health Emergency (PHE) annual reverifications of Medicaid enrollment were paused by the federal government, which meant that those enrolled in Medicaid during that period were not disenrolled. Nationwide Medicaid enrollment rose to a record high during the pandemic, and in Missouri the enrollment also rose to over 1.5 million, a record. Federal law passed at the end of 2022 called for an end to the PHE, and a renewal of the recertification process, commonly called the “unwinding” of the pandemic as it is affecting Medicaid. The process of recertifying enrollment in Medicaid began again in June 2024, which generally had been done on an annual basis before the COVID pandemic, after the unwinding process ended in May 2024. Missouri residents continue to enroll in Medicaid through the expansion, or through other categories, or re-enrolled after losing their coverage (called churning). Thus the numbers reported here show the net effects of the unwinding plus new enrollees.
Enrollment growth led by Adult Expansion Group (AEG). As noted, net enrollment in Missouri’s Medicaid program has increased slightly to 1.267 million in January 2025, slightly higher than the level in December 2024, but nearly identical to the level seen over the last seven months. Recent growth in enrollment is being driven though by a rise of over 15,000 in the Adult Expansion Group (AEG) since May 2024 (and over 6,000 in January 2025 alone). Growth also occurred in the pregnant women category and Women’s Health Services Program (up over 5,000 since May 2024).
This has been offset by drops of over 40,000 in enrollment in other categories — children, persons with disabilities, custodial parents — since May 2024. The changes may suggest that some people who are losing Medicaid coverage through the reverifications are signing up through the AEG, or that there are new enrollees replacing that lost coverage.
Update on Medicaid expansion. As noted, the expansion of Medicaid began in Missouri in July 2021, with the first people enrolled in October 2021. As shown in the graph, the current enrollment in the Adult Expansion Group (AEG) is over 348,000 in Janaury 2025. AEG enrollment fell in the first seven months of the unwinding, but has grown over 14,000 in recent months, perhaps suggesting there is some churning from other categories into the AEG from other populations. Also the Open Enrollment period for the federal marketplaces under the Affordable Care Act took place over the November 2024 to January 2025 period, likely leading to increased applications for the AEG program.
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Report prepared by analysts at Center for Advancing Health Services Policy and Economics Research (CAHSPER), Institute for Public Health (IPH), Washington University in St. Louis.