Medicaid unwinding: More than 18M disenrolled from coverage so far

By Susan Rupe

The Medicaid unwinding is nearly a year old, and more Medicaid recipients than expected have been disenrolled from the public health insurance program, statistics show.

More than 18 million people have been disenrolled from Medicaid since the unwinding began April 1, 2023. This number is up from the 15 million count initially projected by the federal government.

Millions of those who enrolled in Medicaid coverage during the COVID-19 pandemic had been allowed to stay in the program during the federal public health emergency. But the Consolidated Appropriations Act of 2023 delinked the end of the Medicaid continuous enrollment provision from the end of the COVID-19 public health emergency. As a result, the Medicaid continuous enrollment provision ended on March 31, 2023. Beginning April 1, 2023, states were able to terminate Medicaid enrollment for individuals no longer eligible for the coverage. States have up to 12 months to return to normal eligibility and enrollment operations.

How many impacted by the Medicaid unwinding?

KFF reports that as of March 20 – nearly one year into the unwinding - at least 18.67 million Medicaid enrollees have been disenrolled, 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 39.7 million enrollees, had their coverage renewed (one reporting state does not include data on renewed enrollees).

There is wide variation in disenrollment rates across reporting states, ranging from 57% in Utah to 13% in Maine. Some states (such as Texas and South Carolina) are initially targeting people early in the unwinding period that they think are no longer eligible or who did not respond to renewal requests during the pandemic, but other states are conducting renewals based on an individual’s renewal date, said Tammie Smith, KFF spokesperson. Additionally, some states have adopted policies that promote continued coverage among those who remain eligible and have automated eligibility systems that can more easily and accurately process renewals while other states have adopted fewer of these policies and have more manually driven systems.

Across all states with available data, 70% of all people disenrolled had their coverage terminated for procedural reasons, Smith said. However, these rates vary based on how they are calculated. 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.

However, she noted, many who were disenrolled because of paperwork may still be eligible for Medicaid coverage. Some states have temporarily paused procedural terminations for some enrollees while they address problems in the renewal process that lead to increased procedural disenrollments.

What’s behind the Medicaid disenrollment numbers?

The current disenrollment numbers are higher than initially expected, Louise Norris, health policy analyst for healthinsurance.org, told InsuranceNewsNet.

“Initial projections were that somewhere in the range of 16 million to 18 million would lose coverage through the unwinding process, and about 35% of people who have Medicaid still haven’t gone through the process yet. So that number definitely will end up higher than the 18.6 million we’re currently seeing,” she said.

With the majority of those disenrolled from Medicaid removed from the program for procedural reasons, the term “procedural reasons” can mean many things, Norris said.

“They might still be eligible for Medicaid, or they might not,” she said. “But the state didn’t have enough information to know one way or the other. That’s not always a bad thing. It could be that a person who had Medicaid during the pandemic has moved on to a new job and they have health insurance through that job. They don’t see Medicaid anymore and they don’t need it. So when they get the renewal notice in the mail, they throw it away. That would be considered a procedural disenrollment. Because when the state doesn’t get your renewal packet back, they don’t know whether you’re eligible. So you fall in the procedural disenrollment category.”

But most people who are disenrolled for procedural reasons are people who still qualify for Medicaid but didn’t return their information, Norris said.

“Maybe they didn’t receive their renewal information or they didn’t understand it,” she said.

Those who were disenrolled have 90 days to reapply for coverage. Norris said she believes many of that population group will requalify for Medicaid.

Norris said some Medicaid recipients who are no longer eligible for coverage could find themselves eligible to obtain coverage on the Affordable Care Act marketplaces. Brokers and navigators can help them sign up for coverage through a special enrollment period that began when the Medicaid unwinding started.

Susan Rupe is managing editor for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at [email protected]. Follow her on X @INNsusan.

Susan Rupe is editor in chief, magazine, for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at [email protected].