Medicaid Unwinding created a system instability that continues to challenge states in 2025. Ongoing churn, administrative strain, and care disruptions exposed underlying vulnerabilities in Medicaid eligibility and renewal systems.
Key Findings
An Examination of Medicaid Renewal Outcomes and Enrollment Changes at the End of the Unwinding | KFF
- During the unwinding, states redetermined eligibility for everyone on the program and disenrolled those who were no longer eligible and/or those who did not complete the renewal process in full.
- 31% of people whose coverage was redetermined during the unwinding were disenrolled.
- Over 25 million people were disenrolled while over 56 million had their coverage renewed.
Three Questions About Medicaid Unwinding: What We Know and What to Expect | KFF
- During the COVID public health emergency, states were prohibited from disenrolling people from Medicaid in exchange for substantial increase in federal funding.
- Overall, Medicaid enrollment has declined by nearly 10% across states since the start of unwinding (decline of almost 10 million people).
- How states are proceeding with renewals will likely have a substantial effect on the number of people who are dropped from Medicaid, particularly for “procedural” disenrollments, where the renewal process is not completed and there is no way to tell if the person is still eligible for Medicaid or not
- About 70% of disenrollments so far have been “procedural” but the rate varies substantially across states
Lessons From Unwinding Offer Opportunities to Streamline Medicaid, Improve Efficiency | Center on Budget and Policy Priorities
- Many of the individuals who lost Medicaid during the unwinding re-enrolled. This is basic and largely avoidable churn, suggesting that burdensome processes prevented them from renewing their coverage rather than a change in eligibility.
- The increase in application volume due to churn contributed to state backlogs and delays.
Predictions into the Future
Guidelines for Achieving Compliance with Timely Medicaid and CHIP Renewals
- With huge cuts and other changes to the Medicaid program, we expect additional cost and administrative burden for states. This will result in new barriers to accessing health insurance, increased churn as people losing coverage and cycle back in, and worse health outcomes for lower income and higher need populations traditionally served by Medicaid.
- Administrative burdens can be reduced.
- Complex forms, burdensome documentation requirements, and lengthy call center wait times create significant barriers for eligible individuals attempting to maintain their coverage
- These burdens are preventable, and some are inconsistent with longstanding federal regulations that direct states to rely on electronic data for renewals and provide accessible ways for enrollees to complete the renewal process without losing coverage
- State innovations can help bridge communication gaps.
- New communication and outreach strategies during the unwinding process showed promise in reaching enrollees and helping them retain coverage
Conclusion
The Unwinding exposed significant vulnerabilities in the Medicaid eligibility and renewal system, many of which remain unresolved. By modernizing renewal systems and removing administrative burdens, states can reduce churn and ensure eligible individuals remain covered.