The percentage of Americans covered by the Medicaid public health insurance plan decreased from **** percent in 2021 to around **** percent in 2024. However, the percentage of those insured through Medicaid remains lower than the peak of **** percent in 2015. The expansion of Medicaid The Affordable Care Act (ACA) provided the option for states to expand Medicaid eligibility to people whose income was below a particular threshold. The ACA’s major coverage expansion came into force in 2014, and the number of individuals estimated to be enrolled in Medicaid has since surpassed ** million. More than ** million children were enrolled in the program in 2018, representing ** percent of overall Medicaid enrollment. State Medicaid coverage Initially, the ACA mandated that all state Medicaid programs would have to be extended to provide medical coverage to nearly all low-income groups. However, the Supreme Court rejected that part of the act in 2012, leaving the door open for states to make their own decision on whether they expand their plans. As of September 2021, ** states plus the District of Columbia have adopted the Medicaid expansion.

Over ** million Americans were estimated to be enrolled in the Medicaid program as of 2023. That is a significant increase from around ** million ten years earlier. Medicaid is basically a joint federal and state health program that provides medical coverage to low-income individuals and families. Currently, Medicaid is responsible for ** percent of the nation’s health care bill, making it the third-largest payer behind private insurances and Medicare. From the beginning to ObamacareMedicaid was implemented in 1965 and since then has become the largest source of medical services for Americans with low income and limited resources. The program has become particularly prominent since the introduction of President Obama’s health reform – the Patient Protection and Affordable Care Act - in 2010. Medicaid was largely impacted by this reform, for states now had the opportunity to expand Medicaid eligibility to larger parts of the uninsured population. Thus, the percentage of uninsured in the United States decreased from over ** percent in 2010 to *** percent in 2022. Who is enrolled in Medicaid?Medicaid enrollment is divided mainly into four groups of beneficiaries: children, adults under 65 years of age, seniors aged 65 years or older, and disabled people. Children are the largest group, with a share of approximately ** percent of enrollees. However, their share of Medicaid expenditures is relatively small, with around ** percent. Compared to that, disabled people, accounting for **** percent of total enrollment, were responsible for **** percent of total expenditures. Around half of total Medicaid spending goes to managed care and health plans.

In 2023, just four in ten Medicaid/CHIP enrollees were White, non-Hispanic. In comparison, roughly three-quarters of Medicare beneficiaries were White. The Affordable Care Act (ACA) Medicaid expansion in 2014, has helped reduce racial disparities in access to healthcare in the United States. Medicaid eligibility Medicaid provides health coverage to certain low-income individuals, families, children, pregnant women, the elderly, and persons with disabilities. Each state has its own Medicaid eligibility criteria in accordance with federal guidelines. As a result, Medicaid eligibility and benefits differ widely from state to state. Medicaid expansion provision under the Affordable Care Act (ACA) allows states to provide coverage for low-income adults by expanding eligibility for Medicaid to 138 percent of the federal poverty line (FPL). Medicaid coverage gap Uninsured individuals who live in states that have chosen not to expand Medicaid under the Affordable Care Act (ACA) are referred to as being in the Medicaid coverage gap. As of January 2021, 12 states have not adopted the Medicaid expansion provision under the Affordable Care Act (ACA). More than two million uninsured adults fall into this coverage gap, and among them, more than 60 percent are people of color.

The number of older individuals – those aged 65 and older – enrolled in the Medicaid health insurance program was projected to be *** million in 2020. Enrollment is expected to increase year-on-year and is forecast to reach ***** million by 2027.

Which enrollment group is the largest? The percentage of people covered by Medicaid has notably increased since 2000, and enrollment has accelerated in recent years due to the program’s expansion under the Affordable Care Act. The elderly represent the smallest enrollment group, and this looks set to continue in the coming years. The number of disabled enrollees is projected to grow to nearly ****** million, while children are expected to remain the largest enrollment group.

Combining Medicaid and Medicare Aged individuals can qualify for Medicaid based on their low-income or via another eligibility pathway, such as receiving Supplemental Security Income. Some seniors may also qualify for both Medicaid and Medicare, and these dual-eligible beneficiaries receive a comprehensive range of medical support. Medicare is a health insurance program primarily aimed at individuals aged 65 and older – this group accounted for around ** percent of all Medicare enrollees in 2019.

This data set includes annual counts and percentages of Medicaid and Children’s Health Insurance Program (CHIP) enrollees by race and ethnicity overall and by three subpopulation topics: scope of Medicaid and CHIP benefits, age group, and eligibility category. These results were generated using Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF) Release 1 data and the Race/Ethnicity Imputation Companion File. This data set includes Medicaid and CHIP enrollees in all 50 states, the District of Columbia, and Puerto Rico who were enrolled for at least one day in the calendar year. Enrollees in Guam, American Samoa, the Northern Mariana Islands, and the U.S. Virgin Islands are not included. Results shown for the age group and eligibility category subpopulation topics only include enrollees with comprehensive Medicaid and CHIP benefits in the year. Some rows in the data set have a value of "DS," which indicates that data were suppressed according to the Centers for Medicare & Medicaid Services’ Cell Suppression Policy for values between 1 and 10. This data set is based on information shown in the brief: "Race and ethnicity of the national Medicaid and CHIP population in 2020." Enrollees are assigned to six race and ethnicity categories using the state-reported race and ethnicity information in TAF when it is available and of good quality; if it is missing or unreliable, race and ethnicity is indirectly estimated using an enhanced version of Bayesian Improved Surname Geocoding (BISG). Enrollees are assigned to a child (ages 0-18) or adult (ages 19 and older) subpopulation using age as of December 31st of the calendar year. Enrollees are assigned to the comprehensive benefits or limited benefits subpopulation according to the criteria in the "Identifying Beneficiaries with Full-Scope, Comprehensive, and Limited Benefits in the TAF" DQ Atlas brief. Enrollees are assigned to an eligibility category subpopulation using their latest reported eligibility group code, CHIP code, and age in the calendar year. Please refer to the full brief for additional context about the methodology and detailed findings. Future updates to this data set will include more recent data years as the TAF data become available.

California has more Medicaid and CHIP enrollees than any other state in the United States. As of April 2023, approximately ** million Americans were enrolled in the Medicaid health insurance programs in California, which accounted for approximately ** percent of the total number of Medicaid enrollees nationwide (**** million). Blow to Medicaid expansion plans California is one of many states that has expanded its Medicaid program under the Affordable Care Act (ACA) to encourage more low-income adults to sign up for health coverage. One of the original aims of the ACA was to limit some of the variations in state Medicaid programs, but the Supreme Court ruled that the expansion should be optional. Governors of the states that did not expand said they were concerned about long-term costs. California is the leading state for Medicaid expenditure, spending approximately **** billion U.S. dollars in FY2020. Health coverage for children The Children’s Health Insurance Program (CHIP) was created as a complement to Medicaid, expanding the reach of government-funded health coverage to more children in low-income families. As of May 2021, over **** million children were enrolled in Medicaid/CHIP programs in California, more than any other state. As of January 2021, the median Medicaid/CHIP eligibility level for children was *** percent of the federal poverty level.

Context

This public dataset was created by the Centers for Medicare & Medicaid Services. The data summarize counts of enrollees who are dually-eligible for both Medicare and Medicaid program, including those in Medicare Savings Programs. “Duals” represent 20 percent of all Medicare beneficiaries, yet they account for 34 percent of all spending by the program, according to the Commonwealth Fund . As a representation of this high-needs, high-cost population, these data offer a view of regions ripe for more intensive care coordination that can address complex social and clinical needs. In addition to the high cost savings opportunity to deliver upstream clinical interventions, this population represents the county-by-county volume of patients who are eligible for both state level (Medicaid) and federal level (Medicare) reimbursements and potential funding streams to address unmet social needs across various programs, waivers, and other projects. The dataset includes eligibility type and enrollment by quarter, at both the state and county level. These data represent monthly snapshots submitted by states to the CMS, which are inherently lower than ever-enrolled counts (which include persons enrolled at any time during a calendar year.) For more information on dually eligible beneficiaries

Querying BigQuery tables

You can use the BigQuery Python client library to query tables in this dataset in Kernels. Note that methods available in Kernels are limited to querying data. Tables are at bigquery-public-data.sdoh_cms_dual_eligible_enrollment.

Sample Query

In what counties in Michigan has the number of dual-eligible individuals increased the most from 2015 to 2018? Find the counties in Michigan which have experienced the largest increase of dual enrollment households

duals_Jan_2015 AS ( SELECT Public_Total AS duals_2015, County_Name, FIPS FROM bigquery-public-data.sdoh_cms_dual_eligible_enrollment.dual_eligible_enrollment_by_county_and_program WHERE State_Abbr = "MI" AND Date = '2015-12-01' ),

duals_increase AS ( SELECT d18.FIPS, d18.County_Name, d15.duals_2015, d18.duals_2018, (d18.duals_2018 - d15.duals_2015) AS total_duals_diff FROM duals_Jan_2018 d18 JOIN duals_Jan_2015 d15 ON d18.FIPS = d15.FIPS )

SELECT * FROM duals_increase WHERE total_duals_diff IS NOT NULL ORDER BY total_duals_diff DESC

Metrics from individual Marketplaces during the current reporting period. The report includes data for the states using HealthCare.gov. Sources: HealthCare.gov application and policy data through October 6, 2024, HealthCare.gov inbound account transfer data through November 7, 2024, and T-MSIS Analytic Files (TAF) through July 2024 (TAF version 7.1). The table includes states that use HealthCare.gov. Notes: This table includes Marketplace consumers who submitted a HealthCare.gov application from March 6, 2023 - October 6, 2024 or who had an inbound account transfer from April 3, 2023 - November 7, 2024, who can be linked to an enrollment record in TAF that shows a last day of Medicaid or CHIP enrollment from March 31, 2023 - July 31, 2024. Beneficiaries with a leaving event may have continuous coverage through another coverage source, including Medicaid or CHIP coverage in another state. However, a beneficiary that lost Medicaid or CHIP coverage and regained coverage in the same state must have a gap of at least 31 days or a full calendar month. This table includes Medicaid or CHIP beneficiaries with full benefits in the month they left Medicaid or CHIP coverage. ‘Account Transfer Consumers Whose Medicaid or CHIP Coverage was Terminated’ are consumers 1) whose full benefit Medicaid or CHIP coverage was terminated and 2) were sent by a state Medicaid or CHIP agency via secure electronic file to the HealthCare.gov Marketplace in a process referred to as an inbound account transfer either 2 months before or 4 months after they left Medicaid or CHIP. 'Marketplace Consumers Not on Account Transfer Whose Medicaid or CHIP Coverage was Terminated' are consumers 1) who applied at the HealthCare.gov Marketplace and 2) were not sent by a state Medicaid or CHIP agency via an inbound account transfer either 2 months before or 4 months after they left Medicaid or CHIP. Marketplace consumers counts are based on the month Medicaid or CHIP coverage was terminated for a beneficiary. Counts include all recent Marketplace activity. HealthCare.gov data are organized by week. Reporting months start on the first Monday of the month and end on the first Sunday of the next month when the last day of the reporting month is not a Sunday. HealthCare.gov data are through Sunday, October 6. Data are preliminary and will be restated over time to reflect consumers most recent HealthCare.gov status. Data may change as states resubmit T-MSIS data or data quality issues are identified. See the data and methodology documentation for a full description of the data sources, measure definitions, and general data limitations. Data notes: The percentages for the 'Marketplace Consumers Not on Account Transfer whose Medicaid or CHIP Coverage was Terminated' data record group are marked as not available (NA) because the full population of consumers without an account transfer was not available for this report. Virginia operated a Federally Facilitated Exchange (FFE) on the HealthCare.gov platform during 2023. In 2024, the state started operating a State Based Marketplace (SBM) platform. This table only includes data about 2023 applications and policies obtained through the HealthCare.gov Marketplace. Due to limited Marketplace activity on the HealthCare.gov platform in November 2023, data from November 2023 onward are excluded. The cumulative count and percentage for Virginia and the HealthCare.gov total reflect Virginia data from April 2023 through October 2023. APTC: Advance Premium Tax Credit; CHIP: Children's Health Insurance Program; QHP: Qualified Health Plan; NA: Not Available

This map shows where people have Medicaid or means-tested healthcare coverage in the US (ages under 65). This is shown by State, County, and Census Tract, and uses the most current ACS 5-year estimates.

The Share of Medicaid Enrollees in any Managed Care and in Comprehensive Managed CaAre profiles state-level enrollment statistics (numbers and percentages) of total Medicaid enrollees in any type of managed care as well as those enrolled specifically in comprehensive managed care programs. The report provides managed care enrollment by state with all 50 states, the District of Columbia and the US territories are represented in these data. Note: "n/a" indicates that a state or territory was not able to report data or does not have a managed care program. The “Total Medicaid Enrollees” column represents an unduplicated count of all beneficiaries in FFS and any type of managed care, including Medicaid-only and dually eligible individuals receiving full Medicaid benefits or Medicaid cost sharing. The “Total Medicaid Enrollment in Any Type of Managed Care” column represents an unduplicated count of beneficiaries enrolled in any Medicaid managed care program, including comprehensive MCOs, limited benefit MCOs, PCCMs, and PCCM entities. The “Medicaid Enrollment in Comprehensive Managed Care” column represents an unduplicated count of Medicaid beneficiaries enrolled in a managed care plan that provides comprehensive benefits (acute, primary care, specialty, and any other), as well as PACE programs. It excludes beneficiaries who are enrolled in a Financial Alignment Initiative Medicare-Medicaid Plan as their only form of managed care.

In 2024, some *** percent of people aged 65 years and older in the United States had Medicaid health insurance coverage, this was a decrease from the previous year. This statistic illustrates the distribution of people aged 65 years and above with Medicaid coverage in the United States from 2017 to 2024.

In 2023, some 47.6 percent of Medicaid and CHIP enrollees were aged between 18 and 64 years, while adults aged 65 years accounted for only eight percent of enrollees. Medicaid program is funded jointly by the federal and the state governments, it provided coverage to nearly 19.5 percent of the U.S. population in 2022. Medicaid vs CHIPMedicaid and the Children’s Health Insurance Program (CHIP) both provide health insurance coverage for children from low-income families. Children who are not eligible for Medicaid but who would otherwise be unable to obtain insurance through a family plan are covered by CHIP. More than five million children were enrolled in CHIP in the U.S. in 2023. Medicaid and CHIP funding rateThe Federal Medical Assistance Percentages (FMAPs) are used to calculate the amount of federal matching funds for State Medicare and CHIP programs. To encourage states to expand coverage for uninsured children the federal matching rates for CHIP are generally 15 points higher than the Medicaid rate. However, unlike permanent federal funding for Medicaid, CHIP federal funding is capped and due to expire in FY 2027.

Metrics from individual Marketplaces during the current reporting period. The report includes data for the states using State-based Marketplaces (SBMs) that use their own eligibility and enrollment platforms
Source: State-based Marketplace (SBM) operational data submitted to CMS. Each monthly reporting period occurs during the first through last day of the reported month. SBMs report relevant Marketplace activity from April 2023 (when unwinding-related renewals were initiated in most SBMs) through the end of a state’s Medicaid unwinding renewal period and processing timeline, which will vary by SBM. Some SBMs did not receive unwinding-related applications during reporting period months in April or May 2023 due to renewal processing timelines. SBMs that are no longer reporting Marketplace activity due to the completion of a state’s Medicaid unwinding renewal period are marked as NA. Some SBMs may revise data from a prior month and thus this data may not align with that previously reported. For April, Idaho’s reporting period was from February 1, 2023 to April 30, 2023.

Notes:

1. This table represents consumers whose Medicaid/CHIP coverage was denied or terminated following renewal and 1) whose applications were processed by an SBM through an integrated Medicaid, CHIP, and Marketplace eligibility system or 2) whose applications/information was sent by a state Medicaid or CHIP agency to an SBM through an account transfer process. Consumers who submitted applications to an SBM that can be matched to a Medicaid/CHIP record are also included. See the "Data Sources and Metrics Definition Overview" at http://www.medicaid.gov for a full description of the differences between the SBM operating systems and resulting data metrics, measure definitions, and general data limitations. As of the September 2023 report, this table was updated to differentiate between SBMs with an integrated Medicaid, CHIP, and Marketplace eligibility system and those with an account transfer process to better represent the percentage of QHP selections in relation to applicable consumers received and processed by the relevant SBM. State-specific variations are:
   - Maine’s data and Nevada’s April and May 2023 data report all applications with Medicaid/CHIP denials or terminations, not only those part of the annual renewal process. - Connecticut, Massachusetts, and Washington also report applications with consumers determined ineligible for Medicaid/CHIP due to procedural reasons. - Minnesota and New York report on eligibility and enrollment for their Basic Health Programs (BHP). Effective April 1, 2024, New York transitioned its BHP to a program operated under a section 1332 waiver, which expands eligibility to individuals with incomes up to 250% of FPL. As of the March 2024 data, New York reports on consumers with expanded eligibility and enrollment under the section 1332 waiver program in the BHP data. - Idaho’s April data on consumers eligible for a QHP with financial assistance do not depict a direct correlation to consumers with a QHP selection. - Virginia transitioned from using the HealthCare.gov platform in Plan Year 2023 to an SBM using its own eligibility and enrollment platform in Plan Year 2024. Virginia's data are reported in the HealthCare.gov and HeathCare.gov Transitions Marketplace Medicaid Unwinding Reports through the end of 2024 and is available in SBM reports as of the April 2024 report. Virginia's SBM data report all applications with Medicaid/CHIP denials or terminations, not only those part of the annual renewal process, and as a result are not directly comparable to their data in the HealthCare.gov data reports. - Only SBMs with an automatic plan assignment process have and report automatic QHP selections. These SBMs make automatic plan assignments into a QHP for a subset of individuals and provide a notification of options regarding active selection of an alternative plan and/or, if applicable, making the first month’s premium payment.
2. SBMs report on all applicable applications received and not on the Medicaid-defined cohorts of individuals whose renewal is due in a given month. The data in this table are not cumulative and count unique Marketplace activities during the reporting period month in which the relevant activity occurs. As such, activities by any one consumer may be included across reporting months. For example, a consumer who submits an application and receives a determination of QHP eligibility may be counted in one month but his/her plan selection could be counted in a later month. Thus, the percentages do not necessarily depict a direct correlation to the count of consumers on applications received during the current reporting month. Total counts represent activity across the reporting months and are not cumulative as of the latest reporting month. Updated applications in the reporting month are only counted once. Updated applications in a following month may be counted again in that applicable month only if the consumer obtains a new Medicaid/CHIP renewal.
3. SBMs have different operational processes and eligibility systems for handling QHP, Medicaid and CHIP eligibility determinations. While CMS works with SBMs to align the metric definitions across the Marketplaces there can be limitations and anomalies among the SBM data due to different SBM system capabilities. Additionally, variances in the data may be attributable to differences in how states are conducting unwinding renewals including processing timelines and whether states are staging applications for population cohorts (e.g., over age 65).

Percentages shown are of consumers on applications whose Medicaid/CHIP coverage was denied or terminated following renewal during the reporting period month.
Percentages shown are of consumers on account transfers whose Medicaid/CHIP coverage was denied or terminated following renewal during the reporting period month. The percentages for SBMs with integrated eligibility systems and the SBM Total - Integrated and SBM Total data record groups are marked as not available (NA) because SBMs with integrated eligibility systems do not receive account transfers. Additionally, some SBMs with account transfer processes adjusted, with guidance from CMS, the count of "Consumers on Account Transfers Associated with a Medicaid/CHIP Coverage Denial or Termination Following Renewal" to include all consumers on applications who are associated with a Medicaid/CHIP coverage denial or termination following renewal for purposes of calculating the Percent - Account Transfer data record group. For example, Pennsylvania conducts automatic QHP eligibility determinations for Marketplace plans for some account transfers and as of the December 2023 report, revised its data to report those consumers in the account transfer and application metrics. As of the April 2024 report, New Jersey revised its data to report consumers on account transfers and direct applications in the account transfer and application metrics to reflect overall SBM activity in the Percent - Account Transfer data record group.
APTC: Advance Premium Tax Credit; CHIP: Children's Health Insurance Program; QHP: Qualified Health Plan; BHP: Basic Health Program

More than one in four hospitalizations for those with both Medicare and full Medicaid coverage was potentially avoidable, according to findings reported in Medicare-Medicaid Eligible Beneficiaries and Potentially Avoidable Hospitalizations, published in Volume 4, Issue 1 of the Medicare and Medicaid Research Review. Using data from 2007 to 2009, the study examined potentially avoidable hospitalizations rates by setting, state, and medical condition, and the average cost of these events. Beneficiaries in institutions were much more likely to have these events - 16 percent of beneficiaries in the study population were in an institution, yet comprised 45 percent of all potentially avoidable hospitalizations. The range in rates per 1,000 person years across the states was considerable from a low of 59 (Utah) to a high of 197 (Mississippi), a more than a threefold difference. Five conditions were responsible for nearly 80 percent of potentially avoidable hospitalizations. From 2007 to 2009, the national and state rates were fairly consistent.

During a public health emergency in the Families First Coronavirus Response Act (FFCRA), a new optional Medicaid eligibility group was added called COVID-19 testing eligibility group. States reported these expenditures under sections 6004 and 6008 through the Medicaid Budget and Expenditure System (MBES) on the Form CMS-64. The data in these reports constitute summary level preliminary expenditure information related to these FFCRA provisions for each state

Notes: 1. The Families First Coronavirus Response Act (FFCRA), enacted on March 18, 2020, provided a temporary FMAP increase to states and territories meeting certain qualifications and added a new optional
Medicaid eligibility group for uninsured individuals during a public health emergency in section 1902(a)(10)(A)(ii)(XXIII) of the Act, referred to as the “COVID - 19 Testing Group.”
2. FFCRA Section 6008 provides a temporary 6.2 percentage point FMAP increase to each qualifying state and territory's FMAP under section 1905(b) of the Act, beginning January 1, 2020 and lasting through
the end of the quarter in which the public health emergency (PHE) declared by the Secretary for COVID-19 ends, including any extensions.
3. FFCRA Section 6004 provides a 100 percent match rate for individuals eligible under the new optional Medicaid eligibility group in section 1902(a)(10)(A)(ii)(XXIII) of the Act, beginning no earlier than
March 18, 2020 and lasting through the end of the PHE for COVID-19.
4. States that have reported “0” either have no expenditures for that reporting category or have not yet reported expenditures for that category.
5. This report is a cumulative summary report that includes current and prior period adjustment expenditures that apply to this quarter 6. For the Quarter ending 03/31/2020: Delaware has Negative Total Computable Expenditures and Total Federal Share Expenditures due to the reporting of prior period adjustments during this period.
7. For the Quarter ending 09/30/2020: Colorado has Negative Total Computable Section 6004 Covid 19 Expenditures and Total Federal Share Section 6004 Covid 19 Expenditures due to the reporting of prior period adjustments during this period.
8. For the Quarter ending 03/31/2021: California has Negative Total Computable Section 6004 Covid 19 Expenditures and Total Federal Share Section 6004 Covid 19 Expenditures due to the reporting of prior period adjustments during this period. This corrected FY 2020 Q4 expenditures for Treatment services that are not allowed for Section 6004 100% FMAP match. 9. For the Quarter ending 03/31/2021: Utah has Negative Total Computable Section 6004 Covid 19 Expenditures and Total Federal Share Section 6004 Covid 19 Expenditures due to the reporting of prior period adjustments during this period. 10. For the Quarter ending 12/31/2022: California has Negative Total Computable Section 6004 Covid 19 Expenditures and Total Federal Share Section 6004 Covid 19 Expenditures due to the reporting of prior period adjustments during this period. 11. For the Quarter ending 12/31/2022: Connecticut has Negative Total Computable Section 6004 Covid 19 Expenditures and Total Federal Share Section 6004 Covid 19 Expenditures due to the reporting of prior period adjustments during this period. 12. For the Quarter ending 09/30/2023: Connecticut has Negative Total Computable Section 6004 Covid 19 Expenditures and Total Federal Share Section 6004 Covid 19 Expenditures due to the reporting of prior period adjustments during this period.
13. For the Quarter ending 09/30/2023: Illinois has Negative Total Computable Section 6004 Covid 19 Expenditures and Total Federal Share Section 6004 Covid 19 Expenditures due to the reporting of prior period adjustments during this period.
14. For the Quarter ending 09/30/2023: Minnesota has Negative Total Computable Section 6004 Covid 19 Expenditures and Total Federal Share Section 6004 Covid

EMSIndicators:The number of individual patients administered naloxone by EMSThe number of naloxone administrations by EMSThe rate of EMS calls involving naloxone administrations per 10,000 residentsData Source:The Vermont Statewide Incident Reporting Network (SIREN) is a comprehensive electronic prehospital patient care data collection, analysis, and reporting system. EMS reporting serves several important functions, including legal documentation, quality improvement initiatives, billing, and evaluation of individual and agency performance measures.Law Enforcement Indicators:The Number of law enforcement responses to accidental opioid-related non-fatal overdosesData Source:The Drug Monitoring Initiative (DMI) was established by the Vermont Intelligence Center (VIC) in an effort to combat the opioid epidemic in Vermont. It serves as a repository of drug data for Vermont and manages overdose and seizure databases. Notes:Overdose data provided in this dashboard are derived from multiple sources and should be considered preliminary and therefore subject to change. Overdoses included are those that Vermont law enforcement responded to. Law enforcement personnel do not respond to every overdose, and therefore, the numbers in this report are not representative of all overdoses in the state. The overdoses included are limited to those that are suspected to have been caused, at least in part, by opioids. Inclusion is based on law enforcement's perception and representation in Records Management Systems (RMS). All Vermont law enforcement agencies are represented, with the exception of Norwich Police Department, Hartford Police Department, and Windsor Police Department, due to RMS access. Questions regarding this dataset can be directed to the Vermont Intelligence Center at dps.vicdrugs@vermont.gov.Overdoses Indicators:The number of accidental and undetermined opioid-related deathsThe number of accidental and undetermined opioid-related deaths with cocaine involvementThe percent of accidental and undetermined opioid-related deaths with cocaine involvementThe rate of accidental and undetermined opioid-related deathsThe rate of heroin nonfatal overdose per 10,000 ED visitsThe rate of opioid nonfatal overdose per 10,000 ED visitsThe rate of stimulant nonfatal overdose per 10,000 ED visitsData Source:Vermont requires towns to report all births, marriages, and deaths. These records, particularly birth and death records are used to study and monitor the health of a population. Deaths are reported via the Electronic Death Registration System. Vermont publishes annual Vital Statistics reports.The Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) captures and analyzes recent Emergency Department visit data for trends and signals of abnormal activity that may indicate the occurrence of significant public health events.Population Health Indicators:The percent of adolescents in grades 6-8 who used marijuana in the past 30 daysThe percent of adolescents in grades 9-12 who used marijuana in the past 30 daysThe percent of adolescents in grades 9-12 who drank any alcohol in the past 30 daysThe percent of adolescents in grades 9-12 who binge drank in the past 30 daysThe percent of adolescents in grades 9-12 who misused any prescription medications in the past 30 daysThe percent of adults who consumed alcohol in the past 30 daysThe percent of adults who binge drank in the past 30 daysThe percent of adults who used marijuana in the past 30 daysData Sources:The Vermont Youth Risk Behavior Survey (YRBS) is part of a national school-based surveillance system conducted by the Centers for Disease Control and Prevention (CDC). The YRBS monitors health risk behaviors that contribute to the leading causes of death and disability among youth and young adults.The Behavioral Risk Factor Surveillance System (BRFSS) is a telephone survey conducted annually among adults 18 and older. The Vermont BRFSS is completed by the Vermont Department of Health in collaboration with the Centers for Disease Control and Prevention (CDC).Notes:Prevalence estimates and trends for the 2021 Vermont YRBS were likely impacted by significant factors unique to 2021, including the COVID-19 pandemic and the delay of the survey administration period resulting in a younger population completing the survey. Students who participated in the 2021 YRBS may have had a different educational and social experience compared to previous participants. Disruptions, including remote learning, lack of social interactions, and extracurricular activities, are likely reflected in the survey results. As a result, no trend data is included in the 2021 report and caution should be used when interpreting and comparing the 2021 results to other years.The Vermont Department of Health (VDH) seeks to promote destigmatizing and equitable language. While the VDH uses the term "cannabis" to reflect updated terminology, the data sources referenced in this data brief use the term "marijuana" to refer to cannabis. Prescription Drugs Indicators:The average daily MMEThe average day's supplyThe average day's supply for opioid analgesic prescriptionsThe number of prescriptionsThe percent of the population receiving at least one prescriptionThe percent of prescriptionsThe proportion of opioid analgesic prescriptionsThe rate of prescriptions per 100 residentsData Source:The Vermont Prescription Monitoring System (VPMS) is an electronic data system that collects information on Schedule II-IV controlled substance prescriptions dispensed by pharmacies. VPMS proactively safeguards public health and safety while supporting the appropriate use of controlled substances. The program helps healthcare providers improve patient care. VPMS data is also a health statistics tool that is used to monitor statewide trends in the dispensing of prescriptions.Treatment Indicators:The number of times a new substance use disorder is diagnosed (Medicaid recipients index events)The number of times substance use disorder treatment is started within 14 days of diagnosis (Medicaid recipients initiation events)The number of times two or more treatment services are provided within 34 days of starting treatment (Medicaid recipients engagement events)The percent of times substance use disorder treatment is started within 14 days of diagnosis (Medicaid recipients initiation rate)The percent of times two or more treatment services are provided within 34 days of starting treatment (Medicaid recipients engagement rate)The MOUD treatment rate per 10,000 peopleThe number of people who received MOUD treatmentData Source:Vermont Medicaid ClaimsThe Vermont Prescription Monitoring System (VPMS)Substance Abuse Treatment Information System (SATIS)

Medicaid is an important public health insurance for individuals with a low income, those that are pregnant, disabled or are children. It was projected that by 2020 there would be approximately **** million Medicaid enrollees. By 2027 that number is expected to increase to ** million individuals covered.

Medicaid in the focus

Medicaid has recently been in the news for several reasons. A proposed Medicaid expansion was announced with the implementation of the Affordable Care Act in 2010. According to the expansion, all states were given the option to expand Medicaid programs to help provide insurance coverage to millions of U.S. Americans. As of 2019, ** states have accepted federal funding to expand their Medicaid programs. Medicaid, after Medicare and private insurance, provides a significant proportion of the total health expenditures in the United States. In general, Medicaid expenditure, like the number of enrollees, has been growing over time.

Medicaid demographics

A significant proportion of Medicaid enrollees in the U.S. are children and low-income adults. Despite children accounting for most of the enrollees in the Medicaid program, the largest percentage of expenditures for Medicaid is dedicated to those enrolled as a disabled individual. Expenditures for the program also vary regionally. The states with the highest Medicaid expenditures include California, New York and Texas, to name a few.

This table presents the number of pregnant and postpartum Medicaid and CHIP beneficiaries, 2017-2021. It includes (1) the number and percentage of beneficiaries ever pregnant in the year; (2) the number and percentage of live births in the year; (3) the number and percentage of miscarriages, stillbirths, or terminations in the year; and (4) the number and percentage of births with an unknown delivery outcome in the year.

These metrics are based on data in the T-MSIS Analytic Files (TAF). Some states have serious data quality issues, making the data unusable for identifying this population. Data for a state are considered unusable based on DQ Atlas thresholds for the following topics: Total Medicaid and CHIP Enrollment, Claims Volume - IP, Claims Volume - OT, Claims Volume - IP, Diagnosis Code - IP, Diagnosis Code - OT, Procedure Codes - OT Professional. Cells with a value of “DQ” indicate that data were suppressed due to unusable data.

Data from Maryland, Tennessee, and Utah are omitted from the tables due to data quality concerns. Maryland was excluded in 2017 due to unusable diagnosis codes in the IP file and the OT file. Tennessee was excluded due to unusable diagnosis codes in the IP file in 2017 - 2019. Utah was excluded due to unusable procedure codes on OT professional claims in 2017 - 2020. In addition, states with a high data quality concern on one or more measures are noted in the table in the "Data Quality" column. Please refer to the DQ Atlas at http://medicaid.gov/dq-atlas for more information about data quality assessment methods.

Some cells have a value of “DS”. This indicates that data were suppressed for confidentiality reasons because the group included fewer than 11 beneficiaries.

ACA Medicaid expansion effects on SNAP receipt by household income and composition.

The number of people enrolled in Medicaid decreased by *** percent in 2024, while expenditure increased by *** percent. Due to Medicaid unwinding in 2025 Medicaid enrollment is projected to decline by *** percent, while the spending is expected to grow by *** percent. Impact of COVID-19 on Medicaid Approximately ** percent of Americans were covered by Medicaid in 2020. The total number of Medicaid enrollees continues to increase each year and is projected to surpass ** million in 2019. A steadily improving economy in the United States is one reason for the slower enrollment growth experienced in recent years. However, unemployment numbers surged due to the COVID-19 pandemic, and Medicaid enrollment is expected to rise over the coming months as millions of people lose their employer-based health insurance. Medicaid expenditure set to increase Medicaid expenditure in 2019 was projected to *** billion U.S. dollars, an increase year on year. Medicaid spending rose by *** percent in 2020, but the economic downturn caused by COVID-19 is likely to significantly increase both state and federal expenditures. More people are now eligible for Medicaid because they have lost income, and the costs of coronavirus testing and treatment are escalating. Many states may not have the budget to pay for it all, especially at a time when tax revenues are declining.