Analysis: During a year of Medicaid unwinding, some states have caused terrible harm, especially to children and people of color 


March 29, 2024

Editor’s note: April 1, 2024, will be the one-year anniversary of Medicaid unwinding, when state Medicaid programs could terminate families’ health care for the first time since COVID-19 hit America’s shores. Unwinding has caused the most significant changes in American health coverage since the Affordable Care Act passed in 2010. Leading civil rights and health equity groups, including the Leadership Conference on Civil and Human Rights, the NAACP, the National Urban League, the Southern Poverty Law Center, UnidosUS, and the Coalition on Human Needs. today jointly released the analysis below.

Since April 1, 2023, when states were allowed to terminate Medicaid beneficiaries for the first time since 2020, the “unwinding” of COVID-19 continuous coverage requirements has triggered huge Medicaid losses. Based on data from March 26, 2024, Medicaid covers 12 million fewer people than when unwinding began, including almost 5 million fewer children. Although some who lose Medicaid either return to the program or move to other coverage, historically two-thirds experience a brief or prolonged period without any insurance.  

Two-thirds of these Medicaid losses could have been prevented, if all states had done as well as the best states. The range of state outcomes is astounding. In eight states, enrollment fell by 6% or less. In the nine worst-performing states, by contrast, coverage fell by more than 20%, including three states where Medicaid coverage dropped by nearly a third. If all states had protected coverage as effectively as the 10 best states, more than 8 million people would still have their Medicaid today. 

As the Centers for Medicare & Medicaid Services (CMS) reported in December, just five states are responsible for more than half of children’s Medicaid losses: Texas, Florida, Georgia, Ohio, and Arkansas. CMS found that states with large losses were less likely to use the dozens of flexibilities offered by the Biden-Harris Administration for cutting Medicaid red tape that prevents eligible families from keeping their health care.   

People of all races and ethnicities have lost Medicaid, but communities of color have experienced particularly severe harm. Based on underlying state enrollment demographics, Medicaid covers 7 million fewer people of color than before unwinding. This includes almost 4 million fewer Latinos; 2 million fewer African Americans; 500,000 fewer Native Americans; and 500,000 fewer Asian Americans, Native Hawaiians, and Pacific Islanders. 

70% of Medicaid terminations involved people who may be eligible. They were disenrolled for procedural reasons, mainly because states did not record responses to the information requests states sent families.  

Medicaid unwinding has months to go in many states. And in every state, beneficiaries’ eligibility will continue to be redetermined each month, long after unwinding ends. States can and should adopt flexibilities offered by the Administration to cut red tape and help eligible families keep their health care. Among other options, states should follow the path blazed by Kentucky and North Carolina, which protected their children by putting all children’s Medicaid redeterminations on hold for a year.  

In addition, every state should contact the millions of families who have lost Medicaid because of nothing more than missing paperwork and give them the hands-on help that many need to reestablish Medicaid eligibility or transition to other sources of health care. Such outreach and assistance can come from state and local government staff, Medicaid managed care plans, safety-net providers, or community-based organizations.