Medicaid unwinding approaches one-year mark: Disenrolled count surpasses initial expectations, continues to climb

Minneapolis, MN, March 21, 2024 (GLOBE NEWSWIRE) -- The number of Medicaid enrollees disenrolled since the end of the COVID-19 public health emergency has already surpassed the 15 million count initially projected by the federal government; yet about 40 percent of the eligibility redetermination process remains to be completed. Today, healthinsurance.org explains how the Medicaid disenrollments that began April 1, 2023, are affecting health coverage and the nation’s health insurance landscape.

“Heading into Medicaid unwinding a year ago, it was clear the country was facing a monumental shift in healthcare, and the impact has been even larger than anticipated,” said Louise Norris, a health policy analyst for healthinsurance.org. “It’s important to remember that these aren’t just numbers. Each disenrollment represents a person who experienced a significant change in their health coverage situation over the past year. And there are still hundreds of thousands of additional people likely to be impacted in the coming months.”

A look at the numbers

As of March 20, 2024, more than 18 million people have been disenrolled from Medicaid since states resumed disenrollments at the end of the public health emergency. The U.S. Department of Health & Human Services initially projected up to 15 million people would lose Medicaid or Children’s Health Insurance Program coverage. Of the 94 million Medicaid enrollees whose eligibility was to be verified during the Medicaid unwinding, more than 35 million enrollees’ eligibility redeterminations either haven’t been done or haven't been reported.

Here is a look at the data currently available:

During the pandemic, Medicaid disenrollments were paused as part of a continuous coverage provision included in the Families First Coronavirus Response Act. Through March of 2023, Medicaid/CHIPenrollment grew by more than 23 million people as a result of this policy, and because of Medicaid expansion in several states during this time.
Since the beginning of Medicaid unwinding on April 1, 2023, Medicaid has been renewed for almost 40 million beneficiaries.
A majority of Medicaid renewals didn’t require the enrollee to provide any information to confirm eligibility, while about 40% of these confirmations required the enrollee to complete a renewal packet to confirm eligibility.
A significant majority of Medicaid disenrollments were procedural disenrollments, meaning enrollees did not complete the required renewal process to keep their Medicaid coverage.

“The concern with procedural disenrollments is they might be the result of enrollees either not understanding the process, or not having the knowledge, tools or resources to complete it,” said Norris. “During the public health emergency, enrollees weren’t required to prove eligibility to retain their coverage. It’s hard to know how many enrollees understood what was needed for them to retain coverage, even if they were still eligible to remain on Medicaid.”

Many people who are no longer eligible for Medicaid are now eligible for an employer’s health plan and can transition to that coverage. For those who need to obtain their own health insurance, Marketplace coverage is available. Through November 2023, nearly 2.3 million people had transitioned from Medicaid to a private Marketplace plan, and nearly 229,000 had transitioned to Basic Health Program coverage.

The disenrollment process has varied by state

States have up to 12 months to initiate eligibility redeterminations for everyone who was enrolled in Medicaid as of March 2023, although there was some flexibility in terms of when states began this process. Disenrollment plans varied by state, with a few states terminating Medicaid coverage for ineligible enrollees beginning in April 2023, and others waiting until May, June or July. Oregon didn’t begin disenrolling Medicaid enrollees until October.

“Medicaid unwinding has been a massive undertaking for states,” said Norris. “Not only do states have to redetermine eligibility for the record-high number of people enrolled in Medicaid, but they also have to continue to process new applications.”

Here are some insights into disenrollments at the state level, based on data available from the Kaiser Family Foundation:

Texas has disenrolled about 2 million Medicaid enrollees – more than any other state.
Wyoming has disenrolled the fewest Medicaid enrollees of any other state.
Utah has disenrolled the highest percentage (57%) of its completed Medicaid redeterminations, as compared with other states.
Maine has disenrolled the lowest percentage (12%) of its completed Medicaid redeterminations, as compared with other states.

As Medicaid unwinding continues, Medicaid enrollees may continue to receive communications and requests from their state or county Medicaid offices requesting information to help determine their Medicaid eligibility. Healthinsurance.org encourages enrollees to take action if they receive requests for information. Enrollees who don’t respond to requests may be procedurally disenrolled from Medicaid.

Depending on the type of coverage the person is transitioning to, Medicaid enrollees who lose coverage may need to submit their application to a new plan within 60 days. In many states, people who are transitioning to a Marketplace plan can enroll at any time before July 31, 2024, as part of an extended “unwinding special enrollment period.” Individuals who no longer qualify for Medicaid may find that they now qualify for subsidies to help offset the cost of their health insurance premium. This can be true even for individuals who have an employer offer for health insurance if that plan is not considered affordable under the ACA.

Healthinsurance.org provides online resources for consumers about individual and family health insurance. Healthinsurance.org, owned by Healthinsurance.org, LLC, has been providing consumer information about health insurance and health reform for over 25 years.