Medicaid Enrollment and Unwinding Tracker
Note: This tracker was first published on May 3 and is updated regularly as new data become available.
The Medicaid Enrollment and Unwinding Tracker presents the most recent data on monthly Medicaid disenrollments, renewals, overall enrollment and other key indicators reported by states during the unwinding of the Medicaid continuous enrollment provision. The unwinding data are pulled from state websites, where available, and from the Centers for Medicare & Medicaid Services (CMS).
To view data for specific states, click on the State Data tab.
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Medicaid Disenrollments
Medicaid Renewals
Change in Medicaid/CHIP Enrollment
Background
Medicaid Disenrollments
- At least 25,061,000 Medicaid enrollees have been disenrolled as of August 23, 2024, based on the most current data from all 50 states and the District of Columbia. Overall, 31% of people with a completed renewal were disenrolled in reporting states while 69%, or 54.9 million enrollees, had their coverage renewed (one reporting state does not include data on renewed enrollees). Due to varying lags for when states report data, the data reported here undercount the actual number of disenrollments to date.
- There is wide variation in disenrollment rates across reporting states, ranging from 57% in Montana to 12% in North Carolina. A variety of factors contribute to these differences, including differences in renewal policies and system capacity. Some states adopted policies that promote continued coverage among those who remain eligible and/or have automated eligibility systems that can more easily and accurately process renewals. Other states have adopted fewer of these policies and have more manually-driven systems. In addition, North Carolina and South Dakota adopted Medicaid expansion and other states increased eligibility levels for certain populations (e.g., children, parents, etc.) during the unwinding, which may have lowered disenrollment rates in these states.
- Across all states with available data, 69% of all people disenrolled had their coverage terminated for procedural reasons. However, these rates vary based on how they are calculated (see note below). Procedural disenrollments are cases where people are disenrolled because they did not complete the renewal process and can occur when the state has outdated contact information or because the enrollee does not understand or otherwise does not complete renewal packets within a specific timeframe. High procedural disenrollment rates are concerning because many people who are disenrolled for these paperwork reasons may still be eligible for Medicaid coverage.
(Note: The first tab in the figure below calculates procedural disenrollment rates using total disenrollments as the denominator. The second tab shows these rates using total completed renewals, which include people whose coverage was terminated as well as those whose coverage was renewed, as the denominator. And finally, the third tab calculates the rates as a share of all renewals due, which include completed renewals and pending cases.)
Medicaid Renewals
- Of the people whose coverage has been renewed as of August 23, 2024, 61% were renewed on an ex parte basis while 39% were renewed through a renewal form, though rates vary across states. Under federal rules, states are required to first try to complete administrative (or “ex parte”) renewals by verifying ongoing eligibility through available data sources, such as state wage databases, before sending a renewal form or requesting documentation from an enrollee.
Change in Medicaid/CHIP Enrollment
- Since the start of the unwinding, national Medicaid/CHIP enrollment has declined by 13.2 million (13.9%) nationally as of April 2024 (Figure 6). Enrollment declines range from 31.8% in Utah to 2.4% in Hawaii since the start of the unwinding period in each state. North Carolina is the only state that has seen an increase in Medicaid/CHIP enrollment because the state implemented the Medicaid expansion in December 2023. The net changes in Medicaid/CHIP enrollment reflect people who disenroll from Medicaid as states redetermine eligibility during the unwinding, new people who come onto the program, and people who reenroll within a short timeframe following disenrollment, referred to as “churn.” The enrollment decline is measured against each state’s baseline enrollment, which is enrollment in the month prior to when the state resumed disenrollments and which varies by state. (See State Data tab for each state’s baseline enrollment month.)
(Note: As of July 24, 2024, Figure 6 is based on data from CMS, “State Medicaid and CHIP Applications, Eligibility Determinations, and Enrollment Data.” The figure previously utilized enrollment data reported on state websites. Using data from CMS provides standardized enrollment counts and allows for better comparisons across states, although CMS enrollment data lag by three-to-four months and may not match what were previously reported from state websites.)
Background on the Unwinding of the Medicaid Continuous Enrollment Provision
The Medicaid continuous enrollment provision, which had halted Medicaid disenrollments since March 2020, ended on March 31, 2023. Primarily due to the continuous enrollment provision, more than 94 million people were enrolled in Medicaid/CHIP in March 2023, the month before the unwinding period began, an increase of over 22 million from February 2020.
States began disenrolling people from Medicaid in different months, with some states resuming disenrollments in April, others in May or June, and even July 2023 or later for some states. Likewise, states will complete their unwinding periods at different points. The figure below shows the month in which the last cohort of unwinding renewals are scheduled to be completed in each state.
For questions about this tracker, please contact KFFTracker@kff.org