Nearly four million Americans have already had their Medicaid or CHIP eligibility terminated as part of the so-called Medicaid unwinding process, according to data compiled by KFF Health News from state and federal sources.

That figure, moreover, accounts for only 38 states and the District of Columbia.

According to the KFF Medicaid Enrollment and Unwinding Tracker,

• At least 3,790,000 Medicaid enrollees have been disenrolled as of July 27, 2023, based on the most current data from 38 states and the District of Columbia.
• There is wide variation in disenrollment rates across reporting states, ranging from 82% in Texas to 10% in Michigan.
• Although data are limited, children accounted for roughly one-third (32%) of Medicaid disenrollments in seven states reporting age breakouts.
• Across all states with available data, 73% of all people disenrolled had their coverage terminated for procedural reasons.

The KFF Medicaid Enrollment and Unwinding Tracker explains that

Procedural disenrollments are cases where people are disenrolled because they did not complete the renewal process and can occur when the state has outdated contact information or because the enrollee does not understand or otherwise does not complete renewal packets within a specific timeframe. High procedural disenrollment rates are concerning because many people who are disenrolled for these paperwork reasons may still be eligible for Medicaid coverage.

States are reviewing Medicaid renewal applications and terminating eligibility at different rates.  Arkansas and other states began doing so quickly, and by July every state but one had begun terminating Medicaid eligibility; Oregon will not begin doing so until fall.

The Department of Health and Human Services has questioned the manner in which some states have acted, forcing some states to stop removing people from their rolls because of paperwork or application processing problems, and has even required some states to restore some people they had already removed from their Medicaid rolls.  The agency has not identified the states where it has intervened in this manner.

The termination of Medicaid benefits for individuals who qualify for those benefits poses a particularly significant challenge for community safety-net hospitals because those hospitals serve so many more Medicaid and CHIP patients than the typical hospital.  In addition to providing care for which they are not reimbursed, these hospitals face the prospect of trying to continue working with patients who need care but who avoid seeking it because they have been told they no longer qualify for Medicaid.

Learn more about the Medicaid unwinding process and the challenges faced by current Medicaid participants and the state agencies processing their applications to remain in the program from the KFF Medicaid Enrollment and Unwinding Tracker and the Washington Post article “Nearly 4 million in U.S. cut from Medicaid, most for paperwork reasons.”