Medi-Cal growth leads to record high total enrollment
Data from the Department of Managed Health Care and the California Department of Insurance show that total health insurance enrollment in 2022 increased by 4.7% (1.6 million) to a record total of 35.9 million enrollees. This compared to growth of 1.4% in 2021.
Although Medi-Cal managed care was the largest driver of enrollment gains in 2022, enrollment increased or stayed the same in all markets except the individual market. (See Figure 1.) In 2022, Medi-Cal managed care enrollees (13.0 million) exceeded large group market enrollees for the third year in a row.
Medi-Cal managed care growth remains strong amid continuing coverage requirements
Managed care Medi-Cal enrollment grew 10.7% (1.3 million) in 2022, surpassing 13.0 million by the end of the year. (See Table 1.) This was the third straight year of strong Medi-Cal growth and followed increases of 9.2% (927,000) in 2021 and 7.2% (795,000) in 2020 (not shown). The current period of growth in Medi-Cal managed care began in April 2020, coinciding with federal requirements for continued coverage during the COVID-19 public health emergency. After most disenrollments stopped, Medi-Cal managed care enrollment increased by three million people in the three years from December 2019 to December 2022. Moving into 2023, eligibility reviews have resumed and enrollment is expected to Medi-Cal to decrease.
Employer-sponsored insurance records modestly led by ASO
Enrollment in Administrative Services Only (ASO) arrangements for self-insured employers increased 5% (273,000) in 2022. (See Table 1.) Enrollment growth in group markets was positive, but less than 1% . Small group enrollment increased 0.8% (17,000) to 2.3 million in 2022. Large group enrollment increased 0.5% (43,000) to 9.5 million in 2022. Overall, enrollment in the employer-sponsored insurance (ESI) markets reached 17.6 million in 2022, up 1.9% (333,000) from the previous year. (See Figure 2.) By comparison, jobs grew by 3.6% over the same period. (ESI’s markets were defined as large group, small group, and ASO.)
Individual Market Enrollment Denied
The individual market ended 2022 with 2.2 million enrollees, down 5.1% (119,000) from 2021. This compared to steady growth in 2020 (9.7%) and 2021 ( 6.7%). Enrollment declines in 2022 are seen both in Covered California, where eligible participants can receive federal premium subsidies, and outside of Covered California. (See Figure 3.) The decline in individual enrollment through Covered California occurred despite increased federal subsidies and a penalty for not having insurance. Demand for individual coverage may have decreased due to increased enrollment in Medi-Cal and ESI.
The growth of Medicare managed care continues
Medicare enrollment for managed care grew 5% (145,000) to reach a total of 3.1 million enrollees. (See summary tables under document downloads.) About two-thirds of the growth came from SCAN (51,000), Kaiser (30,000) and CVS/Aetna (16,000). (See the latest California Health Enrollment Almanac for details by market and insurer.)
Legacy plan enrollment is additionally denied
Enrollment continued to decline in legacy (formerly “legacy”) plans, those in place before the Affordable Care Act was passed. (See Figure 4.) When 2022 ended, 925,000 commercial subscribers, or 6.1% of the market, remained on legacy plans, down from one million legacy subscribers in 2021.
Look forward
With the end of the federal public health emergency in 2023, the repeal of Medi-Cal’s continuous enrollment policies is expected to result in two to three million enrollees leaving the Medi-Cal program. Most will be eligible for other forms of coverage. The extent to which these enrollees are switching to individual or group insurance is not yet known. It will be important to closely monitor enrollment rates among different sources of coverage, as well as the percentage of the uninsured in 2023 and 2024.