FY 2023 Annual Performance Plan and Report - Strategic Goal 1: Objective 1.1

Fiscal Year 2023
Released March, 2022

Topics on this page: Objective 1.1 Increase choice, affordability, and enrollment in high-quality healthcare coverage | Objective 1.1 Table of Related Performance Measures

Objective 1.1: Increase choice, affordability, and enrollment in high-quality healthcare coverage

HHS supports strategies to increase choice, affordability, and enrollment in high-quality healthcare coverage.  HHS promotes available and affordable healthcare coverage to improve health outcomes in our communities and empowers consumers with high quality healthcare coverage choices.  The Department also leverages knowledge and partnerships to increase enrollment in health insurance coverage.

The Office of the Secretary leads this objective.  The following divisions are responsible for implementing programs under this strategic objective: ACL, AHRQ, ASPE, CMS, HRSA and OASH.  The narrative below provides a brief summary of any past work towards these objectives and strategies planned to improve or maintain performance on these objectives.

Objective 1.1 Table of Related Performance Measures

The purpose of this measure is to increase enrollment in CHIP and Medicaid from 43,542,385 children in FY 2011 to 44,538,869 children by the end of FY 2023.  The agency’s enrollment target for FY 2023 takes into consideration that the prior FY enrollment targets have not been met since FY 2017, and that the majority of eligible children are enrolled in Medicaid and CHIP.  The remaining uninsured children are the hardest to reach.  Under the CHIP and Medicaid programs, States submit quarterly and annual statistical forms, which report the number of children who are enrolled in Medicaid, separate CHIP programs, and Medicaid expansion CHIP programs.  The enrollment counts reflect an unduplicated number of children ever enrolled during each year, and are not reflective of point-in-time enrollment.

The FY 2020 enrollment result as of June 23, 2021 is 44,259,975 children enrolled in Medicaid and CHIP, which does not meet the FY 2020 enrollment target of 46,672,893 children enrolled in Medicaid and CHIP.  The program specific enrollment targets of 37,338,314 children enrolled in Medicaid and 9,334,579 children enrolled in CHIP were also not met by the enrollment results, which indicate that 35,197,225 children were enrolled in Medicaid, and 9,062,750 children were enrolled in CHIP during FY 2020.

The FY 2020 enrollment results should be considered in the context of a recent Urban Institute Analysis highlighting 2019 data that show that nationally, 91.9 percent of children eligible for Medicaid and CHIP are enrolled in these programs, with participation rates at or above 90 percent in 36 states.

CMS has seen continuous enrollment declines through calendar year 2019 and into early calendar year 2020.  This was largely due to factors such as a strong economy, state systems and operational issues, and reducing backlog of delayed redeterminations.  It is important to note that many states’ enrollment totals were impacted by changes to policies and state operations as a result of the COVID-19 public health emergency (PHE). For example, the Families First Coronavirus Response Act (FFCRA) makes available to states a temporary 6.2 percent Federal Medical Assistance Percentage (FMAP) bump that includes a requirement to maintain Medicaid enrollment (for continuous coverage requirement) starting in March 2020.  This requirement increased retention in Medicaid and potentially reduced churn in and out of the Medicaid program throughout the second half of FY 2020.  CMS anticipates an increase in the Medicaid and CHIP enrollment total for FY 2021, as data submitted by states for this timeframe should reflect the growth in enrollment due to policy changes in response to the COVID-19 PHE mentioned above. CMS issued guidance on resuming normal operations related to processing renewals following the end of the PHE on March 3, 2022, and is providing intensive technical assistance to states on this process.

With 91.9 percent of eligible children enrolled in Medicaid and CHIP in 2019, effective and targeted strategies are needed to enroll the remaining 8.1 percent of eligible uninsured children.  Continuous coverage in Medicaid as required by the FFCRA is expected to increase enrollment and retention of children in Medicaid throughout FY 2021 and moving forward for the duration of the COVID-19 PHE.

The Medical Expenditure Panel Survey – Household Component (MEPS HC) Tables Compendia has recently been updated moving to a more user friendly and versatile format (https://meps.ahrq.gov/mepstrends/home/index.html).  Interactive tables are provided for the following: use, expenditures, and population; health insurance, accessibility, and quality of care; medical conditions and prescribed drugs.  The new format greatly expands the number of tables generated dependent on the parameters entered by the user.

The MEPS Tables Compendia is scheduled to be expanded a minimum of 250 tables per year.  For the Insurance Component there are a total of 3,410 national level tables and 6,475 state and metro area tables.  Additionally, there are 1,296 tables available for the MEPS Household Component.  The total number of tables available to the user population is currently 11,181.

The MEPS Tables Compendia is a source of important data that is easily accessed by users.  Expanding the content and coverage of these tables furthers the utility of the data for conducting research and informing policy.  Currently data are available in tabular format for the years 1996 – 2019.  This represents over twenty years of data for both the Household and Insurance Components, enabling the user to follow trends on a variety of topics.

For more than 50 years, HRSA funded health centers have delivered affordable, accessible, quality, and cost-effective primary health care to patients regardless of their ability to pay.  During that time, health centers have become an essential primary care provider for millions of people across the country.  Health centers advance a model of coordinated, comprehensive, and patient-centered primary health care, integrating a wide range of medical, dental, behavioral health, and patient support/enabling services.  Today, approximately 1,400 health centers operate over 13,000 service delivery sites that provide care in every U.S. State, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and the Pacific Basin.  Historically, success in increasing the number of patients served by health centers has been due in large part to the development of new health centers, new satellite sites, and expanded capacity at existing clinics.

In 2020, health centers served 28.6 million patients, a reduction of approximately 1.2 million patients, or 4 percent, due to the impact of the COVID-19 pandemic on the operations of health centers nationwide.  To ensure our nation’s underserved communities and those disproportionately affected by COVID-19 are equitably vaccinated against COVID-19, HRSA in partnership with the Centers for Disease Control and Prevention (CDC) developed the Health Center COVID-19 Vaccine Program to directly allocate COVID-19 vaccines to HRSA-supported health centers.  Through this program, millions of people living in the nation’s medically underserved communities and those disproportionately affected by COVID-19 have received vaccines.  As the impacts of COVID-19 are resolved through national mitigation and resolution strategies, health centers are projected to return to pre-pandemic patient levels.

HRSA funded health centers deliver affordable, accessible, quality, and cost-effective primary health care to patients regardless of their ability to pay.  Health centers emphasize coordinated primary and preventive services that promote reductions in health disparities for low‐income individuals, racial and ethnic minorities, rural communities, and other underserved populations.  In FY 2020, approximately 91 percent of health center patients were individuals or families living at or below 200 percent of the Federal Poverty Guidelines, as compared to approximately 26 percent of the U.S. population as a whole.  The FY 23 target is set based on historical program trends of the composition of health center patients.

1. Medicaid 36,217,330/ CHIP 9,054,332
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2. Medicaid 36,850,065/CHIP 9,212,516
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3. Medicaid 37,152,321/CHIP 9,288,080
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4. Medicaid 37,245,202/CHIP 9,311,300
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5. Medicaid 37,338,314/CHIP 9,334,579
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6. Medicaid 37,338,314/CHIP 9,334,579
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7. Medicaid 35,720,173/CHIP 8,930,043
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8. Medicaid 35,391,786/CHIP 9,147,083
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9. Medicaid 37,080,521/CHIP 8,900,074
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10. Medicaid 36,862,057/CHIP 9,460,160
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11. Medicaid 36,287,063/CHIP 9,632,367
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12. Medicaid 35,090,387/CHIP 9,654,742
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13. Medicaid 35,055,383/CHIP 9,043,038
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