Medicaid Unwinding: Millions Face Coverage Changes as Pandemic Protections End
The unwinding of the Medicaid continuous enrollment provision, enacted during the COVID-19 pandemic, has resulted in significant shifts in enrollment, with millions of Americans facing changes to their health coverage. As of September 12, 2024, states had completed a substantial portion of renewal processes, revealing key trends in disenrollment and renewal rates. This article provides an overview of the latest data and what it means for those enrolled in Medicaid and the Children’s Health Insurance Program (CHIP).
What Was the Continuous Enrollment Provision?
During the COVID-19 public health emergency, states were prohibited from disenrolling individuals from Medicaid, regardless of eligibility. This continuous enrollment provision was designed to ensure healthcare access during a time of widespread economic uncertainty and healthcare strain. With the end of the public health emergency in March 2023, states were able to resume eligibility redeterminations and disenroll those no longer qualifying.
Key Enrollment Trends as of September 2024
As of September 12, 2024, over 25 million people had been disenrolled from Medicaid, representing 31% of completed renewals. Simultaneously, over 56 million enrollees had their coverage renewed, accounting for 69% of completed renewals [KFF]. Nationally, total Medicaid enrollment decreased by 9.3 million individuals (11 percent) between September 2023 and September 2024, although CHIP enrollment increased by 13,000 individuals (0.2 percent) [Medicaid.gov].
State-by-State Disenrollment Rates
Disenrollment rates varied considerably across states, ranging from a high of 57% in Montana to a low of 12% in North Carolina. These differences are attributed to variations in renewal policies, system capacity, and eligibility expansions. States like North Carolina and South Dakota expanded Medicaid during this period, potentially lowering their disenrollment rates [KFF].
Reasons for Disenrollment
A significant portion of disenrollments – nearly seven in ten (69%) – were due to procedural reasons, such as incomplete paperwork or outdated contact information. This suggests that many individuals who were disenrolled may still have been eligible for coverage. Approximately 31% were determined ineligible [KFF].
Ex Parte Renewals
Over half (61%) of renewals were completed on an “ex parte” basis, meaning eligibility was verified through existing data sources without requiring action from the enrollee. Ex parte renewal rates varied significantly by state, from over 90% in Arizona, North Carolina, and Rhode Island to less than 20% in Pennsylvania and Texas [KFF].
What’s Next for Medicaid?
With most states having completed their unwinding renewals by August 2024, the immediate phase of significant enrollment shifts is largely over. However, ongoing monitoring of enrollment trends and access to care will be crucial. The Biden-Harris Administration released guidance in September 2024 to support states in ensuring children enrolled in Medicaid and CHIP receive comprehensive health care services [Syrtis Solutions]. Changes to payment methodologies for COVID-19 vaccine-only visits at Federally Qualified Health Centers, Rural Health Clinics, and Tribal Health Programs are being proposed [DHCS].