Medicaid disenrollments surpass projections in several states

As policymakers consider the impact of Medicaid disenrollment thus far, a new analysis shows eight states have already exceeded projected disenrollment of adults while 12 states surpassed their projected disenrollment of children. These are the main findings of a new analysis from the Urban Institute, funded by the Robert Wood Johnson Foundation.

In earlier research, the Urban Institute projected that enrollment in Medicaid and the Children’s Health Insurance Program would fall by nearly 15 million people between April 2023 and June 2024. This analysis shows net disenrollment through November 2023 is consistent with that projection, having reached 60.5% of the overall projected total. Yet the pace of Medicaid eligibility redetermination has varied considerably across states, with some states exceeding projections.

Key findings from this analysis that examines net Medicaid disenrollment through November 2023 include:

• Medicaid disenrollment exceeded 100% of a state’s total projection in eight states (S.D., N.H., Texas, Ark., Iowa, Idaho, Mont., and Okla.).
• Children were disenrolled at higher rates than adults. Nationally, disenrollments for children reached 84.2% of projections and disenrollments exceeded total projections in 12 states (Mont., Iowa, S.D., Ala., Idaho, Ga., Texas, Ark., Okla., Fla., Miss., Colo.).
• States that said they would complete Medicaid disenrollment in under 12 months, states that obtained few federal waivers to streamline Medicaid coverage renewal, and states that prioritized coverage renewal for those likely to be ineligible had notably higher disenrollment rates relative to other states.

“Certain states disenrolled more people from Medicaid in eight months than we projected would be disenrolled over the full course of the unwinding,” said Matthew Buettgens, senior fellow at the Urban Institute. “This suggests that many eligible people may be among those losing Medicaid and CHIP in some states and raises the possibility that this problem may increase as the unwinding continues.”

“While Medicaid redeterminations are not yet complete, these early data points are consistent with projections that a seismic coverage shift is underway,” said Kathy Hempstead, senior policy adviser at the Robert Wood Johnson Foundation. “The data also show that some states have separated hundreds of thousands of children from their Medicaid coverage, an outcome that was certainly preventable and one that will only further existing health disparities and inequities in the United States.”

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Read the full analysis, “State Variation in Medicaid and CHIP Unwinding for Children and Adults” here.