As States Prepare to “Unwind” the Medicaid Continuous Enrollment Provision, Past Patterns Show That Most People Who Are Disenrolled from Medicaid Become Uninsured for All or Part of the Next 12 Months

Roughly two-thirds (65%) of people who were disenrolled from Medicaid or the Children’s Health Insurance Program (CHIP) in a recent year became uninsured for all or part of the 12 months that followed, a new KFF analysis finds.

The analysis of enrollment data from the 2016-2019 Medical Expenditure Panel Survey (MEPS) suggests that many of the millions of people across the U.S. who are expected to lose Medicaid following the end of the pandemic-era continuous enrollment provision could end up without health coverage for months or more. By 12 months out, however, most people who were disenrolled will have obtained coverage again, either through re-enrolling in Medicaid or transitioning to private insurance.

Beginning April 1, 2023, state Medicaid programs will resume disenrollments for the first time since March 2020. Some people will lose coverage during this “unwinding” because they are no longer eligible for Medicaid and will become uninsured if they do not transition to other coverage, such as the Affordable Care Act (ACA) marketplaces or employer-sponsored insurance. Others will likely lose coverage for administrative reasons — despite still being eligible for Medicaid.

The new study also finds that 41% of people who were disenrolled from Medicaid or CHIP, including some who initially transitioned to other coverage, eventually re-enrolled in the program before a year had passed — a phenomenon of cycling in and out of Medicaid coverage known as “churn”.

In a previous analysis KFF estimated that between 5 and 14 million people will lose Medicaid coverage when states “unwind” the continuous enrollment provision this year.

Although the new findings highlight that many people do not transition to and retain other coverage after they disenroll from Medicaid/CHIP, states’ policies for the unwinding will have a major impact on how successful people will be in moving to other coverage.

State Medicaid agencies can take several steps to reduce coverage disruptions and churn, including improving state eligibility systems, streamlining renewal procedures, communicating with enrollees about the need to complete a renewal, and facilitating transitions to the ACA marketplace or separate Children’s Health Insurance Program (CHIP) coverage for people found ineligible for Medicaid. The federal government has issued guidance aimed at reducing coverage disruptions for Medicaid enrollees and has imposed new reporting requirements to monitor states’ unwinding processes.