Ten months into the unwinding of the Medicaid continuous enrollment provision, states have reported renewal outcomes for half of all enrollees whose eligibility needs to be reviewed during the unwinding period, including 34% (32.1 million) who have had their coverage renewed, and 17% (16.2 million) who have been disenrolled, according to KFF’s latest analysis of state-level data.
There are reasons to expect disenrollment rates to moderate in the second half of the unwinding as states reduce procedural disenrollments and work through “likely ineligible” populations.
Since the start of the unwinding, Medicaid enrollment has declined by about 10% nationally based on the latest available data, with decreases in every state, ranging from 32% in Idaho to 1% in Maine. Two states—South Dakota and North Carolina—expanded Medicaid in 2023, which should limit enrollment declines in those states.
Other state and federal policies could also affect Medicaid enrollment and access to other coverage in the months ahead. Several states may consider proposals to adopt the Affordable Care Act (ACA) Medicaid expansion this year, though the outcomes of those debates are uncertain. In the 10 states that have not adopted Medicaid expansion, nearly 1.5 million uninsured individuals fall into the “coverage gap,” and are not eligible for Medicaid or ACA Marketplace subsidies.
Implementation of 12-month continuous coverage for children and postpartum individuals, as well as extended multi-year continuous eligibility for children in some states, could help to stabilize coverage after the unwinding.
Still, the Medicaid unwinding’s impact on broader coverage trends remains to be seen. While national data show record enrollment in ACA Marketplace coverage, a relatively small share of this growth appears to come from people who have transitioned from Medicaid to the Marketplace. Also, data on the number of people reenrolling in Medicaid after being dropped, transitioning to employer coverage, or becoming uninsured are currently limited.
For more on these and other important Medicaid topics, check out Medicaid: What to Watch in 2024.