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A new KFF analysis finds that between 8 and 24 million people across the U.S. could be disenrolled from Medicaid during the unwinding of the program’s continuous enrollment provision. The estimates draw on data collected through KFF’s recent survey of state Medicaid and CHIP officials, conducted with the Georgetown University Center for Children and Families.
The unwinding of the continuous enrollment provision will play out differently across the states based on policy choices states have made and variation in their administrative infrastructures. Some states have adopted multiple policies that are more likely to promote continued coverage among those who remain eligible.
Between 8 and 24 million people across the U.S. could be disenrolled from Medicaid during the unwinding of the program’s continuous enrollment provision. KFF's new analysis offers three illustrative scenarios for how state-level Medicaid enrollment could decline between March 2023 and May 2024, ranging from 8 percent to 28 percent of total enrollees.
The pandemic continuous enrollment provision and other research show that continuous eligibility reduces Medicaid disenrollment and “churn” rates and helps to ensure stable coverage. As many Medicaid enrollees are currently experiencing disruptions in coverage as a result of the Medicaid unwinding, a number of states are pursuing strategies to help promote continuity of coverage, including through unwinding waivers and Section 1115 demonstration waivers. This Waiver Watch summarizes approved and pending Section 1115 waivers with continuous eligibility provisions for children and adults in Medicaid.
The 23rd annual survey of state Medicaid directors finds that states expect national Medicaid enrollment will decline by 8.6% in state fiscal year (FY) 2024 as state Medicaid agencies continue to unwind pandemic-related continuous enrollment protections. After reaching record high enrollment, these estimates reflect a dramatic year-over-year decline in program enrollment from that high.
Over six months after the expiration of pandemic-era enrollment protections, at least 27 million Medicaid enrollees—or roughly one-in-three enrollees across the country—have completed their state’s eligibility renewal process for the program. Over 18 million people have had their coverage renewed and over 10 million have been disenrolled, as of November 8, 2023.
For 2024, the average Medicare beneficiary has access to 43 Medicare Advantage plans and can choose from plans offered by 8 firms. Among the majority of Medicare Advantage plans that cover prescription drugs, 66 percent will charge no premium in addition to the monthly Medicare Part B premium. As in previous years, the vast majority of Medicare Advantage plans will offer supplemental benefits, including fitness, dental, vision, and hearing benefits.
To better understand the experiences of Medicaid enrollees who have completed the renewal process since the start of the unwinding period, KFF conducted five virtual focus groups in September to learn about their experiences with Medicaid, awareness of the end of the continuous enrollment provision, experiences renewing their coverage since the start of the unwinding, and if they were disenrolled, efforts to regain Medicaid or transition to other coverage.
On November 14, 2023 KFF and the National Association of Medicaid Directors (NAMD) held a web briefing to discuss the latest trends in Medicaid enrollment and spending and highlight key Medicaid policy changes that states implemented in state FY 2023 or plan to implement in FY 2024.
This issue brief analyzes Medicaid enrollment and spending trends for FY 2023 and FY 2024, based on data provided by state Medicaid directors as part of the 23rd annual survey of Medicaid directors in states and the District of Columbia.
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