The process known as “Medicaid unwinding” has now been under way for a year.

When Congress expanded Medicaid eligibility in response to the COVID-19 pandemic it also banned states from removing participants from their Medicaid rolls; the penalty for doing so was reduced federal Medicaid funding, a price no state was willing to pay.

During the course of the pandemic, nationwide Medicaid enrollment rose 22 million, to 94 million last March.

But a year ago states were directed to begin reviewing the eligibility of those then on their Medicaid rolls and to remove those who no longer met eligibility criteria.  States were given 12 months to begin performing eligibility reviews – they all started much sooner – and then another 12 months to complete that work, with most states expressing their intention to complete the task sooner.

With Medicaid unwinding now at the one-year mark, KFF’s “Medicaid Enrollment and Unwinding Tracker” reports the following on the status of Medicaid unwinding:

  • As of March 26, 2024, States Have Reported Renewal Outcomes for Nearly Two-Thirds of People Who Were Enrolled in Medicaid/CHIP Prior to the Start of the Unwinding
  • At Least 19,156,000 Medicaid Enrollees Have Been Disenrolled and 40,597,000 Have Had Their Coverage Renewed, as of March 26, 2024
  • There is wide variation in disenrollment rates across reporting states, ranging from 57% in Utah to 12% in Maine
  • Across all states with available data, 70% of all people disenrolled had their coverage terminated for procedural reasons.
  • Children Account For Almost Four in Ten (37%) of Medicaid Disenrollments in The 21 States Reporting Age Breakouts, as of March 26, 2024
  • Of the people whose coverage has been renewed as of March 26, 2024, 59% were renewed on an ex parte basis while 41% were renewed through a renewal form, though rates varied by state.
  • Net Medicaid enrollment declines range from 32.0% in Utah to 1.1% in Maine since the start of the unwinding period in each state.

Seeing large numbers of their patients lose their Medicaid eligibility poses a special challenge for community safety-net hospitals because those hospitals usually are located in communities with large numbers of low-income residents who are more likely to be enrolled in Medicaid or uninsured than those who live near the typical American hospital.  These residents will continue turning to their community safety-net hospitals for care and those mission-drive community safety-hospitals will need to continue serving those patients – regardless of whether they have health insurance.

Learn more, including information about individual states’ Medicaid unwinding efforts, from the latest report from KFF’s Medicaid Enrollment and Unwinding Tracker.