Nearly 14.4M people disenrolled from Medicaid

A KFF analysis of the latest Medicaid enrollment and disenrollment data showed almost 14.4 million people have lost Medicaid coverage in all 50 states and Washington, D.C., as of Jan. 9, and 71% were disenrolled due to procedural reasons. Disenrollment rates vary widely among reporting states, ranging from 10% in Maine to 62% in Texas, and children accounted for 37% of disenrollment rates in the 23 states that broke up reporting by age.

Overall, 34% of people with a completed renewal were disenrolled in reporting states while 66%, or 26.9 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.

Differences in who states are targeting with early renewals as well as differences in renewal policies and system capacity likely explain some of the variation in disenrollment rates. 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. Additionally, some states have adopted several 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, 71% of all people disenrolled had their coverage terminated for procedural reasons. 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cases where people are disenrolled because they did not complete the renewal process and can occur when the state has outdated contact information or because the enrollee does not understand or otherwise does not complete renewal packets within a specific timeframe. High procedural disenrollment rates are concerning because many people who are disenrolled for these paperwork reasons 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.

Although data are limited, children accounted for roughly four in ten (37%) Medicaid disenrollments in the 23 states reporting age breakouts. As of January 9, 2024, at least 2,490,000 children had been disenrolled out of 6,775,000 total disenrollments in the 23 states. Because Texas has one of the largest Medicaid programs, and because of the limited number of states reporting, Texas has a disproportionate impact on the share of children disenrolled. The share of children disenrolled ranged from 61% in Texas to 19% in Massachusetts.

Of the people whose coverage has been renewed as of January 9, 2024, 60% were renewed on an ex parte basis while 40% were renewed through a renewal form. 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. Ex parte renewal rates vary across states. When looking at all renewals that were due (including disenrollments and pending renewals), 31% were completed via ex parte processes since the start of the unwinding period.

Net Medicaid enrollment declines range from 32% in Idaho to 1% in Maine since the start of the unwinding period in each state. 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. In addition, the latest month of enrollment data also varies by state.

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. As states unwind the continuous enrollment provision over the following 12 months, they will redetermine eligibility for all Medicaid enrollees and will disenroll those who are no longer eligible or who may remain eligible but are unable to complete the renewal process. Millions of people are expected to lose Medicaid coverage during this unwinding period.

States began disenrolling people from Medicaid in different months, with some states resuming disenrollments in April, others in May or June, and even July or later for some states.