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State-based Marketplace (SBM) Medicaid Unwinding Report

Metadata Updated: February 3, 2025

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:

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 appli

Access & Use Information

Public: This dataset is intended for public access and use. License: See this page for license information.

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Dates

Metadata Created Date September 30, 2023
Metadata Updated Date February 3, 2025
Data Update Frequency R/P10Y

Metadata Source

Harvested from Healthdata.gov

Additional Metadata

Resource Type Dataset
Metadata Created Date September 30, 2023
Metadata Updated Date February 3, 2025
Publisher Centers for Medicare & Medicaid Services
Maintainer
Identifier 5670e72c-e44e-4282-ab67-4ebebaba3cbd
Data First Published 2023-07-28
Data Last Modified 2024-12-27
Category Unwinding
Public Access Level public
Data Update Frequency R/P10Y
Bureau Code 009:00
Metadata Context https://project-open-data.cio.gov/v1.1/schema/catalog.jsonld
Metadata Catalog ID https://healthdata.gov/data.json
Schema Version https://project-open-data.cio.gov/v1.1/schema
Catalog Describedby https://project-open-data.cio.gov/v1.1/schema/catalog.json
Harvest Object Id 901d4284-7ea9-46eb-8fdc-0c06bee3e18b
Harvest Source Id 651e43b2-321c-4e4c-b86a-835cfc342cb0
Harvest Source Title Healthdata.gov
Homepage URL https://healthdata.gov/d/aume-h4i3
License http://opendefinition.org/licenses/odc-odbl/
Program Code 009:000
Source Datajson Identifier True
Source Hash 075c66e709d7bb4defdd02879146ca8ac0b60297ba998a60d4bcee048d9b6750
Source Schema Version 1.1

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