Medicaid Unwinding: 10 Essential Facts You Need Now

During the COVID-19 pandemic, Medicaid served as a vital safety net for millions of families. Whether people lost jobs, had hours cut, or needed stable health coverage, Medicaid often filled the gap. To keep coverage continuous, states paused routine eligibility checks because the federal government provided enhanced funding to support that policy.

That protection ended on March 31, 2023. After that date, states resumed eligibility renewals, and millions were required to verify that they still qualified. Below are ten essential points to help you understand what changed, why it matters, and how the unwinding of continuous coverage has affected enrollment.

Continuous Enrollment Changed the Game

During the public health emergency, Congress required states to maintain continuous Medicaid enrollment in exchange for a 6.2 percentage point increase in the federal matching rate. That policy prevented many coverage losses that would have resulted from paperwork issues or temporary income changes. By March 2023, Medicaid and CHIP enrollment had risen to nearly 95 million people—an increase of 23.3 million since February 2020.

The Extra Federal Funding Came With a Deadline

The Consolidated Appropriations Act of 2023 ended the continuous coverage requirement on March 31. States began restarting eligibility checks in April. The enhanced federal match phased down to 5% through June 2023, then 2.5% through September, and 1.5% through December. To retain that additional funding, states had to follow strict renewal procedures and carry out outreach and notice requirements.

Millions Have Already Been Disenrolled

Since the unwinding began, at least 15 million people have been removed from Medicaid rolls. Approximately 71% of those terminations resulted from procedural issues—such as missed forms or unreturned notices—rather than confirmed changes in eligibility. Federal estimates projected between 7.8 million and 24.4 million disenrollments over the first year, with a midpoint near 17 million, reflecting anticipated disruption and uncertainty.

Churn Returned Quickly

Before the pandemic, Medicaid churn—short gaps in coverage caused by changes in eligibility or administrative hurdles—was common. For example, in 2018 about 10.3% of full-benefit enrollees experienced a coverage gap of less than a year. With continuous enrollment paused, churn was suppressed; once redeterminations resumed, the familiar cycle of people cycling on and off coverage returned. States reported increased re-applications from people who had recently lost coverage and were trying to regain benefits.

Paperwork Is Driving Most Coverage Losses

Administrative barriers account for a large share of recent disenrollments. Many people who lost coverage reported no material change in income or household composition. Surveys indicate that numerous enrollees were unaware they needed to actively renew their coverage. Missed renewal notices, incomplete paperwork, outdated contact information, and communication failures have contributed heavily to the decline in enrollment.

States Vary Widely in How They Conduct Renewals

States adopted different timelines and approaches for renewals. Eight states began redeterminations in February 2023, fifteen started in March, and twenty-eight began in April. Many states opted to stagger renewals over 12 to 14 months to handle the workload. Access to renewal support also differed: some states primarily used mail-based renewals, while others faced staffing shortages, long call wait times, and processing backlogs that delayed outcomes.

Automatic Renewals Are Inconsistent

Federal policy requires states to attempt ex parte renewals—using data already on file—before asking enrollees to submit information. But implementation has been uneven. As of January 2023, only 18 states completed at least half of MAGI (modified adjusted gross income) renewals automatically, while eleven states completed fewer than 25%. For non-MAGI groups, such as seniors and people with disabilities, only six states reached the 50% automated renewal threshold.

Federal Oversight Has Increased

The Centers for Medicare & Medicaid Services approved 188 temporary waivers across 47 states by late February 2023. These approvals expanded permitted data sources for renewals and extended timelines for fair hearings in some cases. Several states temporarily paused procedural terminations to address system problems. CMS now requires enhanced, regular reporting on renewals, terminations, and call center performance to monitor the unwinding process more closely.

Some Populations Are More Vulnerable to Losing Coverage

Certain groups have been disproportionately affected by the redetermination process. People who move frequently are more likely to miss renewal notices—about one in ten Medicaid enrollees moved within their state in 2020. Older adults are less familiar with renewal procedures; only about 31% of adults 65 and older had prior renewal experience. Historically higher churn has been observed among Hispanic children, and many states still provide Medicaid information primarily in English, which creates barriers for non-English speakers.

The Uninsured Rate Could Rise Again

Prior to the unwinding, the uninsured rate fell to 8.6% in 2021, tying a historic low. But analysts warn that some of that progress may be reversed. The Congressional Budget Office estimated that 6.2 million people who lose Medicaid coverage could become uninsured within 18 months. Over the coming decade, the uninsured rate could rise—potentially reaching 10.1% by 2033—because relatively few people who lose Medicaid are expected to move directly into Marketplace coverage.