Enrollment in Medicaid and CHIP on Track to Reach 71 Million
Halfway through the largest purge of Medicaid beneficiaries in a one-year period, enrollment in the government-run health insurance program is projected to return to roughly pre-pandemic levels. Medicaid, which covers low-income and disabled individuals, reached a record high of 94 million enrollees due to a rule prohibiting coverage termination during the public health emergency. However, since April 2020, states have removed over 16 million people from the programs in a process known as the “unwinding.” While some no longer qualify due to increased incomes, others have been dropped for procedural reasons. The result is a decrease of approximately 9.5 million enrollees, bringing Medicaid and CHIP enrollment to around 71 million people by the end of the unwinding later this year.
Enrollment Churn and Procedural Issues
Enrollment churn has always been a feature of Medicaid, with around 1 to 1.5 million individuals falling off the rolls each month before the pandemic. During the unwinding, this process has been accelerated and intensified. The Biden administration initially estimated that 15 million people would lose coverage due to procedural issues, but the actual number is likely to exceed 17 million. Approximately 70% of disenrollments are attributed to procedural reasons. However, despite the unwinding, around two-thirds of the 48 million beneficiaries who underwent eligibility review have had their coverage renewed.
State Disparities in Enrollment
The unwinding process has varied across states. Oregon has disenrolled only 12% of its beneficiaries, with 75% having their coverage renewed. In contrast, Oklahoma has dropped 43% of its beneficiaries and renewed coverage for just 34%. The disparities are due to varying eligibility rules and the ease of remaining enrolled. For example, Oregon allows children to stay on Medicaid until age 6 without reapplying and provides up to two years of coverage regardless of income changes. Alabama has successfully communicated the need for reapplication to its enrollees, with only 29% disenrolled for procedural reasons.
Concerns About Children’s Enrollment
While overall Medicaid enrollment is returning to pre-pandemic levels, there is concern about the steeper drop in children’s enrollment. During the unwinding, 3.8 million children have lost Medicaid coverage, which is higher than pre-pandemic levels. The ability for families to get their children back on Medicaid in a timely manner is limited due to a backlog in the system. It remains unclear how many of the millions of people dropped from Medicaid are now uninsured.
The impact of the unwinding on nationwide Medicaid enrollment and the number of uninsured individuals is yet to be determined.