A Closer Look at the Remaining Uninsured Population Eligible for Medicaid and CHIP

During the three years of the pandemic, states maintained coverage for people enrolled in Medicaid. As a result of this continuous enrollment provision, the number of people enrolled in Medicaid increased. The result – in combination with enhanced premium subsidies in the Affordable Care Act marketplace – is that the number of people who were uninsured decreased and the uninsured rate dropped to historic lows. However, despite these improvements in coverage, 25.6 million nonelderly people remained uninsured in 2022 (Figure 1), and six in ten of the uninsured people are eligible for Medicaid (6.4 million or 25%) or subsidized plans (35%) in the Marketplace but are not enrolled in these programs. Among the remaining uninsured, 6% fall into the “coverage gap” because they live in one of the 10 states that have not adopted the Medicaid expansion. People in the coverage gap have incomes too high to qualify for Medicaid in their state, but too low (below 100% of the poverty level) to qualify for subsidies in the Marketplaces. States began the process of unwinding continuous enrollment in the spring/summer of 2023 and have disenrolled millions of people from Medicaid, likely increasing the number of people who are uninsured.

This issue brief examines the characteristics of the nonelderly uninsured population that is eligible for Medicaid or CHIP using the most recent available national survey data from 2022, which is before the end of Medicaid continuous enrollment, and the most recent eligibility levels for Medicaid (from 2023). Even with declines in the uninsured, the characteristics of the uninsured but eligible for Medicaid remained fairly stable from the prior year.


Who are the people who are uninsured and eligible for Medicaid and CHIP?

Among the 6.4 million nonelderly people who are uninsured and eligible for Medicaid or CHIP (referred to as people who are uninsured and eligible for the rest of this brief), most are adults. Two-thirds of people who are uninsured and eligible, 4.2 million, are adults and one-third, 2.2 million, are children (Figure 2). Adults include those eligible for the program through the Medicaid expansion and individuals who qualify under pre-ACA rules but are not enrolled.

Across all people who are uninsured and eligible, over six in ten are people of color and nearly seven in ten live in working families (Figure 2). Nonelderly Hispanic people account for 36.0% of those who are uninsured and eligible, and Black people account for another 13.9%. While just under three in ten (29.6%) of people who are uninsured and eligible are in families with no workers, over half (54.6%) are in families with one or more full-time workers. Both full- and part-time low-wage workers are less likely to report having an offer of coverage from their employer than higher wage workers, and among those with an offer of coverage, are more likely to report the coverage offered is too expensive.

Over three-quarters of the 6.4 million people who are uninsured and eligible (5.2 million people) reside in expansion states, which have more people living in them and have higher Medicaid income eligibility for adults than non-expansion states (Figure 2). The remaining 1.2 million people are in states that have not expanded Medicaid but are eligible for Medicaid or CHIP under traditional (not ACA expansion) pathways. Most of the people who are uninsured and eligible in expansion states are adults, while children make up the majority of uninsured and eligible people in non-expansion states (Figure 2). All states have opted to set eligibility thresholds for children in Medicaid and CHIP at higher levels, in most states above 200% of poverty. In Medicaid expansion states, eligibility for adults was expanded to 138% of poverty ($20,783 for an individual and $35,632 for a family of three in 2024) and extended to adults without children. In non-expansion states, eligibility is limited for adults, often to below half of the federal poverty level, and generally only available for parents of dependent children. The differences in eligibility for adults across expansion and non-expansion states drives the variation in the shares of children and adults who are uninsured but eligible for Medicaid and CHIP for these states.


What are key issues to watch?

Medicaid continuous enrollment contributed to a decline in the number of people uninsured overall as well as the number of uninsured individuals who are eligible for Medicaid but not enrolled. However, since the end of continuous enrollment on March 31, 2023, states have disenrolled millions of people. Although national survey data that will show changes in coverage is lagged, the unwinding of continuous enrollment is expected to increase the number of people who are uninsured, including among those who are still eligible for Medicaid and those who are eligible for subsidies in the Marketplace. Some people who are disenrolled from Medicaid for procedural or paperwork reasons, even though they are still eligible for Medicaid, may struggle to re-enroll and may remain uninsured. Even as the number of people who are uninsured increases, the characteristics of those who are eligible for Medicaid but uninsured may remain relatively stable. Understanding these characteristics can help inform outreach efforts as well as policy changes that can mitigate coverage losses by making it easier for people who are eligible to obtain or retain Medicaid coverage.

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