Medicaid enrollment higher than before the pandemic, KFF finds

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More than 25 million people were disenrolled from Medicaid during the unwinding process, and over 56 million had their coverage renewed. Despite these millions of disenrollments, 10 million more people are currently enrolled in Medicaid and the Children's Health Insurance Program nationally than at the start of the COVID-19 pandemic, finds a new KFF analysis.

Most states ended the unwinding with higher total Medicaid and CHIP enrollment than they began with in February 2020, including seven states where enrollment levels were at least 30% higher.

WHAT'S THE IMPACT?

During the COVID-19 pandemic, states kept people continuously enrolled in Medicaid in exchange for enhanced federal funding, leading to record growth in Medicaid enrollment. After the continuous enrollment policy ended on March 31, 2023 – and under the process referred to as "unwinding" – states were required to complete eligibility renewals for all Medicaid enrollees.

There have always been people eligible for Medicaid but not enrolled, as well as people who get dropped from Medicaid for failing to complete regular renewal processes. During the unwinding period, many states took steps to improve their renewal systems, leading to fewer people getting dropped even though they remain eligible.

Five states – Missouri, Nebraska, North Carolina, Oklahoma and South Dakota – have also adopted Medicaid expansion since the onset of the pandemic, and several states expanded eligibility for other groups, including children. 

The net effect is that Medicaid enrollment is higher than it was before the pandemic.

But at 5% lower, enrollment among children has nearly returned to pre-pandemic levels. Twelve states saw drops in child enrollment and three states saw enrollment fall for both children and adults relative to pre-pandemic levels.

Because Medicaid eligibility levels are more generous for children, these drops in child enrollment – coupled with an increase in the 2023 child uninsured rate – suggest some children may have lost coverage despite being eligible, the authors said.

Overall, 31% of people whose Medicaid coverage was redetermined during the unwinding were disenrolled, with wide differences across states. Five states had disenrollment rates of more than 50% (Montana, Utah, Idaho, Oklahoma and Texas), while five states had rates under 20% (North Carolina, Maine, Oregon, California and Connecticut).

THE LARGER TREND

Last month a group of 188 federal and state organizations sent a joint letter to Congressional and committee leadership urging them to support 12-month continuous eligibility for adults enrolled in Medicaid and CHIP.

Continuous eligibility for Medicaid was in effect during the public health emergency of the COVID-19 pandemic, when the federal government provided funding. Just before the PHE and federal funding ended in May 2023, states began the Medicaid redetermination process. An estimated 16 million people lost their Medicaid coverage. 

Support for continuous eligibility continues to grow, according to the letter. Five states already provide 12-month continuous eligibility to all or some adults and more states are pursuing the policy as a means to ensure eligible enrollees retain their coverage.  

Medicaid and CHIP provide health coverage to more than 80 million Americans.

Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.