US Coverage Changes During Medicaid Unwinding in 2023

Area of Science:

• Health Services Research
• Public Health Policy
• Health Economics

Background:

• The end of the Medicaid continuous coverage provision in April 2023 led to the disenrollment of over 25 million individuals.
• The impact of this unwinding on overall insurance coverage, Medicaid re-enrollment, and healthcare affordability remains largely undetermined.
• Understanding these effects is crucial for evaluating the stability and accessibility of public health insurance programs.

Purpose of the Study:

• To analyze state-level variations in Medicaid coverage losses during the unwinding period.
• To examine trends in new Medicaid applications before, during, and after the COVID-19 public health emergency.
• To assess demographic disparities in coverage changes and impacts on healthcare affordability.

Main Methods:

• A cross-sectional study utilizing administrative data from the Centers for Medicare & Medicaid Services (CMS) and survey data from the National Health Insurance Survey (2019-2023).
• Estimation of state-level Medicaid termination rates and analysis of new application trends.
• Interrupted time series analysis of self-reported Medicaid enrollment, uninsurance rates, and cost-related barriers to care among low-income individuals.

Main Results:

• The median state termination rate during unwinding was 26.6%, with considerable state-level variation.
• Net enrollment decreases were smaller than gross terminations, attributed to re-enrollment and prior coverage awareness.
• Survey data revealed coverage decreases among women, healthier individuals, young adults, recently pregnant adults, and White individuals, with increased cost-related barriers for some groups.

Conclusions:

• Millions experienced Medicaid disenrollment, but survey data suggests smaller overall coverage reductions due to mitigating factors.
• Coverage losses disproportionately affected specific demographic groups, highlighting persistent access and affordability challenges.
• Findings offer insights into the potential consequences of policy changes that may increase administrative hurdles for Medicaid beneficiaries.