Maryland: Hoo boy. I should've waited a few more days...

Just 5 days ago I posted a look at how effectuated ACA healthcare coverage enrollment was going in Maryland for the first quarter of 2026. Since Maryland Health Connection is one of the few states which publishes effectuated enrollment data on a monthly basis, I was able to look at hard enrollment data (along with demographic breakouts) through March.

As I noted last week, Maryland is one of the ten states in which Qualified Health Plan (QHP) selections during Open Enrollment actually increased year over year (by 3.4%).

I also noted that as of March, Maryland is unique in that it's the first state I've seen in which the year over year increase has grown a bit over time, with effectuated enrollment being 12.6% higher than it was a year earlier in January, 4% higher in February and 2.3% higher in March, for a Q1 average effectuated enrollment 6.1% higher than Q1 of 2025.

Finally, I noted that a major part of the reason is that Maryland is fully backfilling 100% of the expired federal tax credits for all enrollees earning 100 - 200% FPL (which make up over 50% of total enrollees), and 50% of the expired credits for enrollees who earn 200 - 400% FPL (another 33% of all enrollees).

HOWEVER, I then added this note:

Even so, it's still a bit surprising that effectuated enrollment is higher year over year (although that seems to be shrinking over time); there was a substantial loss of enrollees below the 100% FPL threshold (due primarily to recent documented immigrants no longer being eligible for any tax credits at all), yet enrollment at nearly every other income bracket increased, in some cases substantially.

Well, it looks like I jumped the gun a bit and even briefly forgot my own warning from months ago:

In fact, the actual enrollment drop won't really be known until after April 1st, because the ACA requires insurance carriers to provide a 90-day grace period for non-payment of premiums...which means anyone who fails to make their January payment may not officially drop off the "effectuated enrollee" list until April...and if the July reports don't include April effectuations, it won't show up then either.

Well, this week the Maryland Health Connection posted their April effectuated enrollment data, and sure enough...

In one fell swop, April effectuated enrollment dropped sharply by over 6%, bringing the 4-month average enrollment down to just 3% higher than it was in 2025.

Here's what that looks like visually:

It's also worth noting that the makeup of those still effectuated as of April is vastly different than it was according to the Open Enrollment plan selection data.

By income bracket (ie, percent of the Federal Poverty Level):

• Under 100% FPL: Plan selections dropped 49%...but April effectuated enrollment is down a whopping 82%.
• 100 - 200% FPL Plan selections increased 19%...but April effectuated enrollment is only up 7%.
• 200 - 400% FPL: Plan selections increased 6%...but April effectuated enrollment dropped 7%.
• Over 400% FPL: Plan selections increased 2%...while April effectuated enrollment increased 3%.

With April added to the mix, here's what Maryland looks like for the balance of the year:

• If the rest of the year follows the 2025 pattern, effectuations will end December at around 209,000 and will average around 228,000 for the year...down 3.2% y/y.

• If the rest of the year follows the 2019 pattern, effectuations will be at around 203,000 by December, and the average for the year will be around 220,000...down 6.6% y/y.