What the Unwinding Revealed
The Medicaid unwinding was more than a return to routine eligibility operations. It tested whether state renewal systems could perform under sustained pressure. Many could not.
During the unwinding, states were required to redetermine eligibility for every Medicaid member. About 31 percent of reviewed members were disenrolled. While more than 56 million people successfully renewed coverage, over 25 million lost it. Total Medicaid enrollment fell by nearly 10 percent nationwide.
These outcomes exposed a core issue: Enrollment stability depends as much on administrative execution as on eligibility policy.
Administrative Friction Drove Disenrollment
Roughly 70 percent of disenrollments occurred because members did not complete required paperwork or renewal steps. While many of these individuals later re-enrolled, the pattern matters. It signals that coverage losses were often procedural rather than appropriate eligibility determinations.
The resulting churn increased application volume and overwhelmed state systems. Processing delays grew. Backlogs persisted. Staffing shortages made recovery difficult. And the administrative burden did not end when the unwinding did.
The Same Weaknesses Persisted in 2025
The structural issues revealed during Medicaid unwinding remain in place. High churn continues to create gaps in coverage for eligible members. States still face renewal backlogs, fragmented data, and limited outreach capacity.
The disconnect between eligibility and renewal outcomes has not been resolved. Communication gaps, manual processes, and inconsistent data sharing continue to drive unnecessary disenrollment. For Medicaid programs, this creates avoidable cost, operational strain, and disruption for members.
Why This Matters Heading into 2026 (and 2027)
Enrollment volatility will remain a feature of the system, not an exception.
Upcoming Medicaid policy changes will increase the pressure with more frequent redeterminations and the addition of community engagement requirements (i.e., work requirement). Together, they raise administrative risk and reduce continuity of coverage for millions who rely on Medicaid.
Without changes to how eligibility redeterminations are executed, many eligible members will continue to experience gaps in coverage leaving states to manage churn rather than prevent it.
Applying the Lessons Learned from Medicaid Unwinding
States that act on unwinding lessons have a clear path forward. Simplified renewal processes reduce procedural terminations. Stronger data sharing across the Medicaid ecosystem improves eligibility verification. Proactive, targeted outreach keeps eligible members enrolled.
These are operational imperatives as we look to the full implementation of Medicaid policy changes. When executed well, operationalization will stabilize Medicaid member enrollment, reduce administrative waste, and protect continuity of coverage.
The Medicaid unwinding provided the evidence. The next phase will test whether states acted on their experiences.