When pandemic-era continuous eligibility to enroll in Medicaid ended in April 2023, no one could have been entirely clear as to how many individuals would lose their coverage. Nearly final numbers are now in. In total, coverage was renewed for 56 million individuals by the end of the unwinding period and 25 million people were disenrolled or 31%, according to a September 18 issue brief from the Kaiser Family Foundation. 

Through this analysis, one message comes through loud and clear: It matters where you live. 

According to the study, five states had disenrollment rates that exceeded 50%: Idaho, Montana, Oklahoma, Texas and Utah. 

At the other end of the spectrum, five states had disenrollment rates under 20% -- California, Connecticut, Maine, Oregon and North Carolina. 

Montana had the highest rate of disenrollment at 57%, while North Carolina had the lowest rate at 12%. (North Carolina was also among the five states that expanded Medicaid eligibility based on the Affordable Care Act since the beginning of the pandemic. It did this in 2023).

According to the brief, the disenrollment figure was higher than KFF predicted, with 69% of those who were disenrolled having been terminated for “paperwork or procedural reasons.”

To put the disenrollment numbers and percentages in context, the number of adults and children covered by this federal/state insurance program grew from 71 million in February 2020 to 94 million when the unwinding began in April 2023. In May 2024, when reenrollment and disenrollment was generally completed, enrollment was at 81 million.

The KFF brief includes data on total disenrollment and renewal for all fifty states. A few other takeaways:

• Adult enrollment in general is more than 20% higher than in February 2020, while child enrollment is 5% higher.

• Many states improved their renewal processes during the unwinding and “several states expanded eligibility for certain groups”.

• Total Medicaid/CHIP enrollment is higher than before the pandemic in all but three states: Montana, Colorado and Arkansas, but child enrollment is lower in 12.

In addition, according to the brief, one lesson learned from the pandemic and the unwinding experience is that continuous enrollment stabilizes coverage “by reducing churn in the program that occurs when eligible people are disenrolled and then reenrolled within a short period of time.” At the beginning of 2024, federal policy changed so that all states are now required to provide children with 12 months of continuous enrollment. This was previously a state option.  Some states now go beyond that extending continuous enrollment for young children for longer periods.

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