By Victoria Bailey

The Families First Coronavirus Response Act required Medicaid to provide continuous coverage for beneficiaries throughout the COVID-19 pandemic. With disenrollments paused, Medicaid and the Children’s Health Insurance Programme (CHIP) enrollment grew by over 23 million beneficiaries.

The continuous coverage policy ended with the public health emergency, and states could begin coverage redeterminations on April 1, 2023. HHS had projected that 15 million beneficiaries would lose Medicaid coverage. However, as of March 20, 2024, more than 18 million people have been disenrolled. What’s more, 35 million beneficiaries’ eligibility redeterminations have either still not been completed or have not been reported.

Disenrollment numbers and processes have varied across states. Starting from April 2023, states have up to twelve months to initiate redeterminations. Some states began disenrollments in April, while others waited until May, June, or July. Oregon did not resume coverage determinations until October.

 “Medicaid unwinding has been a massive undertaking for states,” a health policy analyst for healthinsurance.org, Louise Norris said. “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.”

Texas has disenrolled the most Medicaid beneficiaries so far at 2 million, while Wyoming has disenrolled the fewest number at 5,300 beneficiaries, according to KFF data. Utah has disenrolled the highest percentage of its completed Medicaid redeterminations (57%), and Maine has disenrolled the lowest percentage (12%).

Since the Medicaid unwinding started, coverage has been renewed for 40 million beneficiaries. Most renewals did not require beneficiaries to provide any information to confirm their eligibility, but 40 per cent of cases required individuals to complete a renewal packet for confirmation.

The majority of disenrollments were due to procedural reasons, meaning beneficiaries did not complete the required renewal process to maintain coverage. These beneficiaries may have misunderstood the process, not had the resources to complete it, or may not even know they had to complete anything.

Many people who lost Medicaid eligibility are now eligible for an employer-sponsored health plan. Individuals have also transitioned to marketplace coverage. Through November 2023, nearly 2.3 million people moved from Medicaid to a marketplace plan, while 229,000 had transitioned to Basic Health Programme coverage.

Disenrolled beneficiaries moving to a marketplace plan can enroll before July 31, 2024, as part of an extended unwinding special enrollment period. These individuals may qualify for premium subsidies to offset costs.