Medicaid Unwinding: 25M+ Disenrolled, Renewal Rates & State Data (Sept 2024)

The unwinding of the continuous enrollment provision in Medicaid and the Children’s Health Insurance Program (CHIP) has resulted in significant shifts in enrollment, with over 25 million people disenrolled as of September 12, 2024. This process, initiated after three years of paused disenrollments during the COVID-19 pandemic, is now largely complete, offering a clearer picture of eligibility and access to coverage. Understanding these changes is crucial for individuals, healthcare providers, and policymakers alike.

Renewal Outcomes and Disenrollment Rates

As states resumed verifying eligibility through renewals beginning in April 2023, the impact on enrollment became apparent. Data indicates that approximately 31% of completed renewals resulted in disenrollment, while 69% led to coverage renewal. Yet, these figures vary considerably across states, ranging from a high of 57% disenrollment in Montana to a low of 12% in North Carolina. The Kaiser Family Foundation (KFF) provides a comprehensive tracker detailing these state-specific outcomes.

A significant factor driving these differences is the approach states took to renewal policies, and procedures. Some states prioritized continued coverage through automated systems and streamlined processes, while others relied more heavily on manual reviews. North Carolina and South Dakota, for example, saw lower disenrollment rates partly due to Medicaid expansion and increased eligibility levels during the unwinding period.

Procedural Disenrollments: A Cause for Concern

Perhaps the most concerning aspect of the disenrollment data is the reason *why* people lost coverage. Nearly seven in ten (69%) of those disenrolled were removed from the rolls for procedural reasons – meaning they didn’t complete the renewal process, often due to outdated contact information or difficulty navigating the paperwork. This suggests that a substantial number of individuals who remained eligible for Medicaid were inadvertently dropped from coverage.

It’s significant to understand how these procedural disenrollment rates are calculated. Different methods yield different results. One calculation uses total disenrollments as the denominator, while another uses total completed renewals. A third considers all renewals due, including those still pending. Regardless of the method, the high proportion of procedural disenrollments highlights the need for improved communication and simplified renewal processes.

Ex Parte Renewals and Automated Eligibility

On the positive side, a significant portion of renewals – 61% – were completed on an “ex parte” basis. This means states were able to verify ongoing eligibility using existing data sources, such as state wage databases, without requiring individuals to take any action. This automated approach is crucial for maintaining coverage for those who remain eligible and minimizes administrative burden. However, ex parte renewal rates also varied widely, from over 90% in states like Arizona, North Carolina, and Rhode Island, to less than 20% in Pennsylvania and Texas.

National Enrollment Trends

As of November 2025, there are approximately 76 million people enrolled in Medicaid/CHIP nationally. This represents a decrease from the record high of 94 million enrollees reached during the continuous enrollment period. The decline reflects both disenrollments of those no longer eligible and the impact of procedural issues. The Centers for Medicare & Medicaid Services (CMS) provides monthly enrollment data and insights into these trends.

State Data and Ongoing Monitoring

Detailed state-level data on renewal outcomes are available through the KFF Medicaid Enrollment and Unwinding Tracker. Archived data allows for a deeper dive into specific state experiences. CMS also publishes cumulative renewal data, though these figures may differ slightly from state-reported data due to variations in reporting timelines and methodologies.

What to Expect Moving Forward

While most states completed their unwinding renewals by August 2024, ongoing monitoring of enrollment trends and renewal outcomes remains essential. CMS will continue to collect and analyze data to identify areas for improvement and ensure equitable access to coverage. States should focus on strengthening communication with enrollees, simplifying renewal processes, and leveraging automated eligibility verification systems.

For individuals with Medicaid coverage, it’s crucial to ensure contact information is up-to-date with the state Medicaid agency and to respond promptly to any renewal requests. Those who believe they were incorrectly disenrolled should contact their state Medicaid agency to explore reinstatement options. Resources and contact information can be found on state Medicaid websites.

The Ohio Department of Medicaid also provides regular updates on payment system issues that may affect providers, available on their News for Providers page. While this is specific to Ohio, it illustrates the ongoing efforts to address challenges within the Medicaid system.

the unwinding of continuous enrollment serves as a critical test of the Medicaid program’s ability to efficiently and effectively serve its beneficiaries. Continued vigilance and proactive measures are needed to ensure that those eligible for coverage can access the care they need.