Between 5.3 million and 14.2 million low-income people could lose Medicaid coverage following the end of the public health emergency and federal continuous enrollment requirement, KFF researchers find in a new analysis. We arrive at those estimates after examining two potential scenarios about how states might manage the resumption of eligibility redeterminations and disenrollments.
KFF analysts also project that, from fiscal year 2020 through fiscal year 2022, states will have collectively spent $47.2 billion to cover additional people enrolled in Medicaid because of the continuous enrollment requirement and will have received $100.4 billion in new federal funds to cover those costs and provide general fiscal relief through enhanced Medicaid matching funds.
Based on the analysis, we estimate that enrollment will have risen by 25 percent, to a projected 110.3 million, by the end of fiscal year 2022. That would be 22.2 million more people than were enrolled in fiscal 2019, before the pandemic. We attribute most of the increase to the continuous enrollment requirement that helped to ensure coverage for enrollees during the pandemic and halted churn or temporary lapses in coverage due to enrollees cycling on and off the program in short periods of time.
In a recent KFF survey of state Medicaid directors in the field in February 2022, state officials projected that median Medicaid enrollment would decline by 5 percent next year following the end of the public health emergency. Another KFF survey from January 2022 found states expect on average about 13 percent of Medicaid enrollees to be disenrolled following the end of the continuous enrollment requirement (with estimates ranging from 8% to over 30%).These recent survey results illustrate the great deal of uncertainty surrounding how states will implement the end of the continuous enrollment requirement and how many individuals will lose coverage.
In the new analysis, KFF researchers examine two potential scenarios based on these survey results, estimating that a 5 percent decline in Medicaid enrollment would translate into a decline of 5.3 million enrollees and a 13 percent decline in Medicaid enrollment would translate into a decline of 14.2 million enrollees. There was a wide range in state estimates, so in any given state the share of enrollees losing coverage could be lower or higher than these illustrative estimates.
The biggest losses are expected to be among adults made eligible for coverage by the Affordable Care Act’s Medicaid expansion, other adults eligible for Medicaid other than due to a disability, and children, as these were the groups that experienced the largest increase during the pandemic. Researchers did not examine how many of the people who lose Medicaid might be able to find coverage from other sources such as the ACA Marketplace, how many might become uninsured and how many might still be eligible for Medicaid but face barriers in retaining coverage.
In exchange for abiding by the continuous enrollment requirement, states became eligible for a 6.2 percentage point bump in the federal Medicaid match rate (“FMAP”) to help them manage rising enrollment and rapidly provide broader fiscal relief by allowing states to reduce state Medicaid spending at a time when states experienced significant drops in revenue early in the pandemic.
KFF analysts find that over time states will have received pandemic-related federal Medicaid money amounting to more than double the higher state Medicaid costs they have faced due to increased enrollment. We did not examine how states used the fiscal relief. State spending on Medicaid is likely to increase following the expiration of the public health emergency and the loss of enhanced federal funding, even after factoring in the expected declines in Medicaid enrollment.
States that have not expanded Medicaid under the ACA have tended to draw more federal fiscal relief than expansion states during the pandemic, chiefly because the enhanced federal matching money does not apply to the ACA adult expansion population.
The new analysis uses data from a companion KFF analysis also released today. In the second analysis, KFF researchers more closely examine typical Medicaid enrollment patterns before the pandemic.
The full analyses are:
For more data and analyses related to Medicaid and the pandemic, visit kff.org