Health Law Daily Wrap Up, GENERAL HEALTH CARE NEWS: KFF looks at post-Medicaid ‘unwinding’ enrollment, (Sep 20, 2024)

By Leah S. Poniatowski, J.D.

Analysis shows nationally more adults enrolled in Medicaid and CHIP programs than before the COVID-19 pandemic, but the rates vary state-by-state.

An analysis provided by KFF examined the enrollment statistics for Medicaid and CHIP from before the COVID-19 pandemic, during the pandemic-era continuous enrollment policy, and the unwinding of that policy that began in April 2023. Based on their data, KFF observed that 94 million people were enrolled in the federal programs by April 2023, and during the unwinding, roughly 30 percent were disenrolled. Although enrollment rates for adults is 20 percent higher than before the pandemic, child enrollment is only 5 percent higher, and these numbers vary depending upon the state.

Background. KFF relied on data from its Medicaid Enrollment and Unwinding Tracker in penning the report examining the enrollment rates across the states from February 2020, before the COVID-19 pandemic, through May 2024, the most recent available federal enrollment data. KFF looked at the national and state rates during this period, which was impacted by the pandemic-era policy protecting Medicaid coverage by keeping individuals continuously enrolled, and then the unwinding period during which states individually adjusted their policies. KFF plans to track the monthly enrollment data as reported by CMS.

Findings. As an overview, nationally 71 million people were enrolled in Medicaid and CHIP in February 2020, which grew to 94 million by April 2023, which marked when states began unwinding from the pandemic policy. The states were tasked with reevaluating who could remain in the federal programs and removing those who did not qualify or did not renew enrollment.

National. Based on KFF’s data, following the expiration of the pandemic policy, more than 25 million individuals were removed from enrollment, and more than 56 million renewed their coverage. Nationally, the number of adults enrolled in the federal programs is 20 percent higher than the pre-pandemic level and the number of children is 5 percent higher. KFF stated that the growth in enrollment could be attributed to certain factors, including individuals previously eligible but had not enrolled, improvements in state processing of eligibility, and state expansions for eligibility. KFF also remarked that the continuous enrollment policy was effective at stabilizing coverage, and now states are required to provide 12 months of continuous eligibility for children. Additionally, several states are offering multi-year continuous eligibility for young children and some states are offering it for older children and adults.

States. Looking at the states individually, the disenrollment rates vary significantly. KFF showed that Montana, Utah, Idaho, Oklahoma, and Texas had more than 50 percent disenrolled, while North Carolina, Oregon, Maine, California, and Connecticut had less than 20 percent disenrolled. However, in most of the states total enrollment is higher than it was before the pandemic, with states like Missouri and North Carolina seeing enrollment rates at or above 50 percent. KFF attributed these increases to expansion in the eligibility of these programs. On the other side, a handful of states saw enrollment numbers fall below the pre-pandemic numbers. Child enrollment was down in twelve states and adult enrollment down in four, with Montana and Colorado being thinly states with both adult and child rates below the pre-pandemic levels.

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