Halfway Through ‘Unwinding,’ Medicaid Enrollment Is Down About 10 Million

We’re halfway through the Medicaid “unwinding,” in which states are dropping people from the government health insurance program for the first time since the pandemic began.

Millions of people have been dumped from the rolls since April, often for procedural issues like failing to respond to notices or return paperwork. But at the same time, millions have been re-enrolled or signed up for the first time.

The net result: Enrollment has fallen by about 9.5 million people from the record high reached last April, according to the latest estimates by KFF, based on state data. That leaves Medicaid on track to look, by the end of the unwinding, a lot like it did at the start of the coronavirus pandemic: covering about 71 million people.

“What we are seeing is not dissimilar to what we saw before the pandemic — it is just happening on a bigger scale and more quickly,” said Larry Levitt, executive vice president for health policy at KFF.

Enrollment churn has always been a feature of Medicaid, which covers low-income and disabled Americans. Even before the pandemic, about 1 million to 1.5 million people fell off the Medicaid rolls each month — including many who still qualified but failed to renew their coverage, Levitt said.

In the unwinding, a lot of people have been disenrolled in a shorter period of time. In some ways — and in some states — it’s been worse than expected.

The Biden administration predicted about 15 million people would lose coverage under Medicaid or the related Children’s Health Insurance Program during the unwinding period, nearly half due to procedural issues. Both predictions were low. Based on data reported so far, disenrollments are likely to exceed 17 million, according to the KFF report, 70 percent of them due to procedural reasons.

But about two-thirds of the 48 million Medicaid beneficiaries who have had their eligibility reviewed so far got their coverage renewed. About one-third lost it.

Timothy McBride, a health economist at Washington University in St. Louis, said the nation’s historically low unemployment rate means people who lose Medicaid coverage are more likely to find job-based coverage or better able to afford plans on Obamacare marketplaces. “That is one reason why the drop in Medicaid is not a lot worse,” he said.

There are big differences between states. Oregon, for example, has disenrolled just 12 percent of its beneficiaries. Seventy-five percent were renewed, according to KFF. The rest are pending.

At the other end of the spectrum, Oklahoma’s dumped 43 percent of its Medicaid beneficiaries in the unwinding, renewing coverage for just 34 percent. About 24 percent are pending.

States have varying eligibility rules, and some make it easier to keep people enrolled. For instance, Oregon allows children to stay on Medicaid until age 6 without having to reapply. Everyone else gets up to two years of coverage regardless of changes in income.

Joan Alker, executive director of the Georgetown University Center for Children and Families, said she remains worried the drop in Medicaid enrollment among children is steeper than typical. That’s particularly bothersome because children usually qualify for Medicaid at higher household income levels than their parents or other adults.

More than 3.7 million children have lost Medicaid coverage during the unwinding, according to the center’s latest data. “Many more kids are falling off now than prior to the pandemic,” Alker said.

And when they’re dropped, many families struggle to get them back on, she said. “The whole system is backlogged and the ability of people to get back on in a timely fashion is more limited,” she said.

The big question, Levitt said, is how many of the millions of people dropped from Medicaid are now uninsured.

The only state to survey those disenrolled — Utah — discovered about 30 percent were uninsured. Many of the rest found employer health coverage or signed up for subsidized coverage through the Affordable Care Act marketplace.

What’s happened nationwide remains unclear.

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Phil Galewitz:
pgalewitz@kff.org,
@philgalewitz