10 Things to Know About the Medicaid Unwinding
During the pandemic, Medicaid became a lifeline for millions of families. If you lost a job, had hours cut, or just needed steady health coverage, Medicaid was often there. States kept people enrolled without the usual paperwork because the federal government offered extra funding to do so.
That protection ended on March 31, 2023. States restarted eligibility checks, and millions suddenly had to prove they still qualified. Here are 10 clear things you need to understand about what happened and why it matters.
Continuous Enrollment Changed The Game
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During the COVID-19 emergency, Congress required states to keep people enrolled in Medicaid and offered a 6.2 percentage point increase in federal funding in return. That rule prevented coverage losses tied to paperwork or short income swings. By March 2023, Medicaid and CHIP covered nearly 95 million people, an increase of 23.3 million since February 2020.
The Extra Federal Money Came With A Countdown
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The Consolidated Appropriations Act of 2023 ended continuous coverage on March 31, 2023. States restarted eligibility checks in April. The federal match stepped down to 5% through June 2023, 2.5% through September, and 1.5% through December. To keep that funding, states had to meet strict renewal requirements and conduct outreach.
Millions Have Already Been Disenrolled
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Since the unwinding started, at least 15 million people have lost Medicaid coverage. About 71% of those losses were due to procedural issues, such as missing paperwork, not because people were found ineligible. Federal estimates projected between 7.8 million and 24.4 million disenrollments over a year, with a midpoint of roughly 17 million, highlighting the expected disruption.
Churn Made A Fast Comeback
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Before the pandemic, Medicaid churn was common. In 2018, 10.3% of full-benefit enrollees had a coverage gap of less than 1 year. Continuous enrollment was paused for that cycle. Once redeterminations resumed, the revolving door reopened, with agencies reporting spikes in re-applications from people who had only recently lost coverage.
Paperwork Is Doing Most Of The Damage
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Most coverage losses are linked to administrative hurdles rather than confirmed ineligibility. Many people who were disenrolled report no change in income or household status. Surveys suggest a large number did not realize they had to actively renew their coverage. Missed notices, incomplete forms, outdated contact information, and communication breakdowns are responsible for much of the recent enrollment decline.
States Are All Over The Place On Renewals
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Renewal schedules varied widely across the country. Eight states began in February 2023, 15 in March, and 28 in April. Most states chose to spread renewals over 12 to 14 months to manage the workload. Access has also been uneven. Some states rely heavily on mail renewals, while others have faced staffing shortages, long call center wait times, and processing delays.
Automatic Renewals Are Uneven At Best
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Federal rules require states to attempt ex parte renewals using existing data. In January 2023, only 18 states completed at least 50% of MAGI renewals automatically. Eleven states completed fewer than 25%. For non-MAGI groups, including seniors and people with disabilities, just six states reached the 50% mark.
Federal Oversight Has Intensified
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Centers for Medicare & Medicaid Services approved 188 temporary waivers across 47 states by February 24, 2023. These waivers expanded data use and extended fair hearing timelines. Some states paused procedural terminations to fix system issues. CMS now requires monthly reporting on renewals, terminations, and call center activity.
Some Groups Face Higher Risk Than Others
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Certain groups face a greater risk during the unwinding. People who move often miss renewal notices, and in 2020, 1 in 10 Medicaid enrollees relocated within their state. Only 31% of adults age 65 and older had prior renewal experience. Hispanic children have historically experienced higher churn, and 19 states still provide English-only Medicaid homepages.
The Uninsured Rate Could Rise Again
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The uninsured rate dropped to 8.6% in 2021, tying a historic low. But projections suggest that progress may reverse. The Congressional Budget Office estimates that 6.2 million people losing Medicaid will become uninsured within 18 months. Over time, the uninsured rate could climb to 10.1% by 2033, as relatively few shift directly into Marketplace coverage.