Medicaid Expansion & July 2017 State Report

Medicaid Expansion, a key provision of the Affordable Care Act, provides a significant opportunity to increase health coverage for tribal members and help your local community all while increasing local clinic resources.

Medicaid Expansion greatly expands the number of American Indians and Alaska Natives now covered under Medicaid. It increases Medicaid to now cover individuals younger than 65 with incomes below 138 percent of the Federal Poverty Line (FPL), or $15,856 for an individual and $32,499 for a family of four in 2014. This is especially important since it opens a new pathway for young men, women, and single adults to gain more comprehensive health care.

The ACA holds the government more accountable to the trust responsibility by expanding health coverage of American Indians and Alaska Natives through greater access to Medicaid.


Medicaid and CHIP Highlights: 2017


The July 2017 Medicaid and CHIP Application, Eligibility Determinations, and Enrollment Report (ZIP 260.02 KB) represents state Medicaid and Children’s Health Insurance Program (CHIP) agency activity for the month. The report is one of a series of reports on state Medicaid and CHIP data, and it includes point-in-time data reported by states. Updated Medicaid and CHIP application, eligibility determinations, and enrollment data is available on

As with previous reports, this month’s report contains preliminary data and includes data for all states on the following indicators (the term “states” includes all 50 states and the District of Columbia):

  • The number of applications submitted directly to Medicaid and CHIP agencies, including those received through State-Based Marketplaces (SBMs);
  • The number of eligibility determinations made by Medicaid and CHIP agencies on the applications described above, as well as applications to the Federally-Facilitated Marketplace (FFM) in states for which the FFM makes an eligibility assessment (and the state then completes the Medicaid or CHIP determination); and
  • The total number of individuals enrolled in the Medicaid and CHIP programs who are receiving comprehensive benefits, including details on the total number of children enrolled in these programs.

Read additional background information about the monthly enrollment report.

Highlights from the July 2017 Report

Medicaid and CHIP Total Enrollment

bar chart state map74,300,298 individuals were enrolled in Medicaid and CHIP in the 51 states reporting July 2017 data. 68,474,422 individuals were enrolled in Medicaid and 5,825,876 individuals were enrolled in CHIP (please see contextual information below regarding CHIP enrollment). Over 16.4 million additional individuals were enrolled in Medicaid and CHIP in July 2017 as compared to the period prior to the start of the first Marketplace open enrollment period (July – Sept. 2013), in the 49 states that reported relevant data for both periods, representing nearly a 29 percent increase over the baseline period. (Connecticut and Maine aren’t included because they did not report data for both periods). View graph of Medicaid and CHIP Enrollment Growth over Baseline.

Medicaid Child and CHIP Total Enrollment

people and bar chartOver 35.6 million individuals are enrolled in CHIP or are children enrolled in the Medicaid program in the 48 states that reported child enrollment data for July 2017. Children enrolled in the Medicaid program and individuals enrolled in CHIP make up approximately 50.3 percent of total Medicaid and CHIP program enrollment. View graph of Medicaid Child and CHIP Enrollment.

Important Contextual Information

  • Not all states are included in each of these figures due to missing data. Also, some states included in these figures report data that deviate from CMS’s specifications. For a listing of state-specific notes and data quality limitations, please see the full report (ZIP 260.02 KB).
  • Other sources of enrollment data, including data from the Statistical Enrollment Data System (SEDS) and Medicaid Budget and Expenditure System (MBES), may not align with the enrollment data included in this report because of methodological differences. For example, in the most recent published SEDS annual enrollment report, CHIP enrollment was reported as over 8.9 million. Unlike the point-in-time, monthly enrollment counts included in this report, the SEDS CHIP enrollment figure represents the number of individuals ever enrolled in CHIP throughout the year. SEDS total and state-specific annual enrollment data is available at. SEDS total and state-specific annual enrollment data.
  • All states reported enrollment data for July 2017; however, only 49 states reported both July 2017 enrollment data and data from July-September 2013. These 49 states reported total enrollment in July 2017 of over 73.2 million individuals, and July-September 2013 average enrollment of over 56.8 million. For July 2017, CMS is reporting growth of 16,432,539 compared to July-September 2013 in the 49 states reporting data for both periods.
  • The July-September 2013 data may contain individuals with retroactive Medicaid coverage, and the July 2017 data included in this report is preliminary. Therefore, the difference reported here between July 2017 and July-September 2013 period is likely understated.
  • In the 51 states that reported Medicaid and CHIP enrollment data for both June and July 2017, Medicaid and CHIP total enrollment declined by over 127,000 in July as compared to June. States reported similar declines in both the updated April, May and June 2017 reports.

Through the Affordable Care Act and the Indian Health Care Improvement Act, IHS, tribal, and urban Indian (I/T/U) clinics can bill Medicaid and the Children’s Health Insurance Program (CHIP) for the services they provide to this expanded population. In many states, Medicaid and CHIP may be known by another name but are similar programs. When a patient is enrolled in Medicaid or CHIP and uses their I/T/U clinic, the clinic can bill the government for the services provided and bring additional funding into the Indian Health Care System. Serving a population with more health insurance not only means building a healthier community for all, but also means that the Indian Health Service can extend services provided locally.

Additionally, the third party billing that is collected must remain at the local clinic, ensuring local tribal members will enjoy the benefits from enrolling in alternative coverage.
Unfortunately, not all states have chosen to expand Medicaid. However, many American Indians and Alaska Natives in your community may still be eligible under the previous Medicaid qualifications and simply have not signed up yet. This is a great opportunity to educate your tribal members about the benefits of Medicaid and how they can be an active solution to the IHS funding gap through third party billing for services – helping their community and increasing resources for all.

Although some states have made initial decisions to not expand Medicaid, they still have the choice to expand later. In some cases, tribal leaders have become major advocates for Medicaid Expansion to help their tribal communities.



“Current Status of State Medicaid Expansion Decision, 2014,” The Henry J. Kaiser Family Foundation, accessed May 7, 2014