National Medicaid and CHIP enrollment is declining. According to data reported by the Centers for Medicare & Medicaid Services (CMS), millions were disenrolled from Medicaid over the 16 months following the start of the unwinding of the continuous enrollment provision on April 1, 2023.
Why is Medicaid enrollment dropping?
The decline in enrollment stems from the end of a federal requirement established during the COVID-19 pandemic. To ensure stability during the health crisis, Congress enacted legislation that included a provision that Medicaid programs keep people continuously enrolled in exchange for enhanced federal funding.
This provision ended in March 2023. Starting April 1, 2023, states began “unwinding” the rolls.
How many people are losing coverage?
Enrollment reached a high of 94 million enrollees in March 2023 when the continuous enrollment provision ended. Since the unwinding began, the number of disenrolled individuals has reached the millions.
The rate of disenrollment varies by state.
What happens to those who lose Medicaid?
Individuals who are no longer eligible for Medicaid may transition to other forms of health insurance. Many move to the Health Insurance Marketplace, where they can purchase Qualified Health Plans (QHPs) with subsidies based on their income.
The transition often depends on the timing of the disenrollment. A loss of Medicaid coverage qualifies as a “Life Event,” triggering a Special Enrollment Period (SEP) that allows individuals to enroll in a Marketplace plan outside of the standard Open Enrollment window.
How is CHIP enrollment affected?
The Children’s Health Insurance Program (CHIP) serves as a safety net for children. Since April 2025, CHIP enrollment has increased in 20 states.
Comparison of Disenrollment Types
| Disenrollment Type | Primary Cause | Common Example |
|---|---|---|
| Procedural | Administrative or communication failure | State sends renewal form to an old address; enrollee never receives it. |
| Eligibility-Based | Change in financial or residency status | Enrollee receives a raise that pushes their income above the federal poverty level (FPL) limit. |
What happens next for Medicaid enrollees?
States continue to process their remaining redeterminations. Passage of the 2025 reconciliation bill in July 2025 included significant changes to Medicaid that are expected to reduce Medicaid enrollment over the next 10 years relative to what would have been expected under current law.