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Updated: Jan 15, 2026

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US Coverage Changes During Medicaid Unwinding in 2023.

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Summary

Millions lost Medicaid coverage during its unwinding, with significant state variation. Survey data showed smaller coverage reductions due to re-enrollment and pandemic coverage awareness, but some groups faced affordability issues.

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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.