Dive Brief:

• A record one in four Americans are now covered by Medicaid and the Children's Health Insurance Program, following a sharp spike in enrollment during the coronavirus pandemic, according to new government data.
• Over 80.5 million individuals now have health insurance coverage through the safety-net programs. Nearly 10 million people enrolled between February last year, a month before the COVID-19 national emergency began, and January 2021 — a 14% jump from old enrollment stats.
• Medicaid accounted for the bulk of the new enrollees. The Biden administration attributed the jump in enrollment to stronger federal incentives during the public emergency, and officials praised Medicaid for keeping Americans insured during the COVID-19 economic upheaval.

Dive Insight:

Medicaid and CHIP are now the largest single source of health coverage in the U.S., passing the roughly 63 million people covered by Medicare.

Top Biden administration health officials HHS Secretary Xavier Becerra and CMS Administrator Chiquita Brooks-LaSure said the enrollment data illustrate how Medicaid and CHIP were a lifeline to millions during the pandemic.

"This report reminds us what a critical program and rock Medicaid continues to be in giving tens of millions of children and adults access to care," Becerra said in a statement. "This pandemic taught us that now more than ever, we must work to strengthen Medicaid and make it available whenever and wherever it's needed using the unprecedented investments Congress provided."

Most notably, the Families First Coronavirus Act, passed in March last year, gave states a temporary 6.2% increase in federal match funds in the Medicaid program as long as that made sure eligible beneficiaries stayed enrolled and covered during the national emergency.

CMS also gave states a number of regulatory flexibilities in shaping their Medicaid programs during COVID-19.

However, millions of enrollees could get removed from the Medicaid rolls next year as states resume eligibility checks, which were put on hold during COVID-19. Once the national emergency expires, expected at the end of this year, states will once again comb over their Medicaid rolls to determine eligibility, removing beneficiaries who no longer qualify due to a change in income.

Patient advocates have aired worries about people being booted off the program due to administrative error or faulty information as states scramble to restart a process that's been suspended for two years.

The Biden administration has said it's focused on keeping the gains in coverage seen during COVID-19. HHS is currently ironing out a rule to streamline the Medicaid and CHIP "application, eligibility determination, enrollment and renewal processes," according to a list of ongoing rules posted by the White House Office of Management and Budget.

Private insurers also have incentives to keep Medicaid's gains in place, as the ballooning safety-net program is contributing to significant amounts of revenue. More states are contracting with payers to manage their Medicaid programs — currently, seven out of each 10 Medicaid enrollees are in plans run by an insurance company, according to the Kaiser Family Foundation. That's especially benefited payers with large government books of business like Centene and Molina.

Of the roughly 9.9 million people who joined Medicaid and CHIP from February 2020 to January 2021, about 9.7 million joined Medicaid and about 124,000 joined CHIP. At the end of January, there were about 73.8 million people in Medicaid and 6.8 million in CHIP.