Medi-Cal Growth Drives Overall Enrollment to Record High
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 the 2022 enrollment gains, enrollment increased or remained the same in all markets except the individual market. (See Figure 1.) In 2022, Medi-Cal managed care enrollment (13.0 million) exceeded enrollment in the large group market for the third year in a row.
Medi-Cal Managed Care Growth Remained Strong Under Continuous Coverage Requirements
Medi-Cal managed care enrollment grew by 10.7% (1.3 million) in 2022, exceeding 13.0 million by year-end. (See Table 1.) This was the third consecutive 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 the federal requirements for continuous coverage during the COVID-19 public health emergency. With most disenrollments halted, Medi-Cal managed care enrollment expanded by three million people in the three years from December 2019 through December 2022. Moving into 2023, eligibility reviews resumed, and Medi-Cal enrollment is expected to decline.
Employer-Sponsored Insurance Enrollment Grew 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 the 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 employer-sponsored insurance (ESI) markets reached 17.6 million in 2022, increasing 1.9% (333,000) over the prior year. (See Figure 2.) By comparison, jobs grew 3.6% during the same period. (ESI markets were defined as large group, small group, and ASO.)
Individual Market Enrollment Declined
The individual market ended 2022 with 2.2 million enrollees, down 5.1% (119,000) from 2021. This compared to robust growth in 2020 (9.7%) and 2021 (6.7%). Enrollment decreases in 2022 occurred both in Covered California, where eligible enrollees may obtain federal premium subsidies, and outside Covered California. (See Figure 3.) The decline in individual enrollment through Covered California occurred despite the availability of enhanced federal subsidies and a penalty for not having insurance. Demand for individual coverage may have been reduced due to increased enrollment in Medi-Cal and ESI.
Medicare Managed Care Growth Continued
Medicare managed care enrollment grew 5% (145,000) to reach 3.1 million total enrollees. (See summary tables under document downloads.) Some two-thirds of the growth came from SCAN (51,000), Kaiser (30,000), and CVS/Aetna (16,000). (See the latest California Health Care Almanac on health insurance enrollment for the details by market and insurer.)
Legacy Plan Enrollment Declined Further
Enrollment continued to fall in legacy (formerly “grandfathered”) plans, those in force before passage of the Affordable Care Act. (See Figure 4.) When 2022 ended, 925,000 commercial enrollees, or 6.1% of the market, remained in legacy plans, down from one million legacy enrollees in 2021.
With the end of the federal public health emergency in 2023, the unwinding of Medi-Cal continuous enrollment policies are expected to result in two to three million enrollees leaving the Medi-Cal program. The vast majority will be eligible for other forms of coverage. The extent to which these enrollees transition to individual or group insurance is still unknown. It will be important to closely monitor enrollment levels among different coverage sources as well as the uninsured rate in 2023 and 2024.