Why are Medicaid enrollment rates going to drop, and how many people could it impact?

A pandemic provision kept states from disenrolling Medicaid recipients for years. Under the Consolidated Appropriations Act, this provision ended on March 31, 2023.

The Office of Health Policy projects that 17.4% of those enrolled in Medicaid and the Children's Health Insurance Program (CHIP), or approximately 15 million people, will lose coverage. Here’s how millions gained or continued coverage over the pandemic — and who will lose coverage soon.

How did Medicaid enrollment change during the pandemic?

Congress passed the continuous enrollment provision under the Families First Coronavirus Response Act at the onset of the pandemic. This policy prevented states from disenrolling Medicaid recipients to ensure public health needs were met.

During the pandemic, states received a temporary increase in Medicaid funding with the expectation that enrollment rates would increase.

Between 2020 and 2022, Medicaid enrollment grew by approximately 20 million people. As a result of this policy, the nation hit a historic low uninsured rate of 8% at the beginning of 2022.

As of January 2023, over 93 million people were enrolled in Medicaid and CHIP.

The pandemic led to a substantial increase in Medicaid enrollment, thanks in part to policies like continuous enrollment, public outreach efforts, and expanded subsidies under the American Rescue Plan.

These changes increased Medicaid enrollment across all states between 2020 and 2022. Oklahoma and Missouri had the most considerable changes in Medicaid enrollment, by 90% and 70%, respectively.

While continuous enrollment ended on March 31, 2023, states can choose when to begin rolling back Medicaid benefits. Certain states will wait until later this year, while others have already begun the process.

Who is at risk of losing their Medicaid benefits?

As many as 15 million people could lose their access to Medicaid due to the end of these pandemic-era provisions.

Roughly 8.2 million people are expected to lose Medicaid due to ineligibility.

Another 6.8 million people could lose Medicaid coverage despite still being eligible^[1], meaning they can re-enroll within a short period of time. This process, referred to as administrative churning, occurs when individuals experience frequent and sometimes unnecessary changes in their Medicaid status. This can arise due to administrative factors, such as paperwork errors or processing delays.

An estimated 383,000 people projected to lose eligibility for Medicaid would fall in the coverage gap in the remaining 12 non-expansion states, with incomes too high for Medicaid but too low to receive Marketplace tax credits.

The continuous enrollment provision also provided funding matches for CHIP recipients, meaning the enrollment changes will also impact them.

How does this differ by age, race, and income level?

The Office of Health Policy has also predicted that people of certain age groups, races and ethnicities, and income levels will see higher disenrollment rates in the coming months.

Children and young adults are the most affected by these Medicaid rollbacks; roughly 4 million children will temporarily lose access and will have to reapply.

Latino and Black, non-Latino Medicaid recipients of all ages will be disproportionately impacted by Medicaid cuts compared to historical enrollment rates.

While most of those losing Medicaid eligibility earn incomes above the federal poverty level (FPL), the temporary loss of Medicaid for the 3.8 million people living in poverty could lead to short-term financial issues.

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