Continuous Eligibility Policies And CHIP Structure Affected Children's Coverage Loss During Medicaid Unwinding

In April 2023, with the "unwinding" of the Families First Coronavirus Response Act (FFCRA) continuous enrollment provisions in Medicaid, states were permitted to commence redetermination and disenrollment procedures for Medicaid beneficiaries. Using Centers for Medicare and Medicaid Services monthly state enrollment data for forty-nine states and Washington, D.C., from the period January 2021-December 2023, we examined changes in children's Medicaid and Children's Health Insurance Program (CHIP) coverage during the Medicaid unwinding, both overall and by whether states had previous twelve-month continuous eligibility policies for children and by the structure of states' programs for CHIP. We found substantially lower Medicaid and CHIP enrollment among children during the unwinding than during the FFCRA period, with lower levels of coverage declines among children in states that had previous twelve-month continuous eligibility policies and states with a program structure of separate CHIP or Medicaid expansion CHIP, rather than combination CHIP. These findings highlight the consequences of the FFCRA unwinding for children's Medicaid and CHIP enrollment, as well as potential state health policies that can promote coverage continuity and prevent further coverage loss for children moving forward.