Where things stand months after states have resumed Medicaid eligibility determinations

States are several months into Medicaid unwinding—a process that began in earnest this spring when Covid-era rules incentivizing states to halt Medicaid and Children’s Health Insurance Program (CHIP) eligibility determinations ended after three-plus years.

Health officials in many states have approached redeterminations differently.

Some, for example, started the renewal process for certain cohorts as early as February, while most states began in April or later. The majority of states opted to spread the unwinding over 12 months, and two chose to do so over 10 months. Meanwhile, 22 states have prioritized individuals who they’ve determined are likely ineligible to renew their Medicaid or CHIP benefits.

The efforts have led to varying state-level results and complications—and some critics have described the process as “chaos.” All states and DC finished at least one full renewal cohort as of August 31, according to the Centers for Medicare and Medicaid Services (CMS).

Here’s where the redetermination process stands at the end of 2023:

Between March and the end of August, state health officials across the US started eligibility determinations for nearly 41 million people, including more than 27 million whose renewals were due during that five-month period, according to the latest data from CMS.

About half of the 27 million participants (13.5 million people) had their Medicaid or CHIP coverage renewed—8 million of which came on an ex parte basis (an automatic renewal process) and 5.5 million were based on a renewal form, CMS reported in the National Summary of Renewal Outcomes released in November.

State health officials terminated coverage for more than a quarter (7.5 million) of renewals due between March and August. “Procedural reason” accounted for most of those denials (5.5 million), according to CMS. The remaining 2 million beneficiaries, meanwhile, were deemed ineligible for Medicaid or CHIP coverage. Those people can enroll in coverage through their state or federal health insurance exchanges.

A Kaiser Family Foundation (KFF) tracker, which is based on the newest data from all 50 states and DC, put the total Medicaid disenrollments closer to 12 million as of December 7. The health policy research nonprofit estimated that as many as 17 million people could lose Medicaid coverage during the redeterminations.

More than 6 million of the nearly 41 million renewals initiated between March and August were still pending at the end of that reporting period, according to CMS.

About 17 million on average lose Medicaid or CHIP coverage each year due to ineligibility or other factors like bureaucracy, according to CMS officials. In theory, that means an estimated 50+ million enrollees may have stayed covered by the health insurance programs during the pandemic—regardless of their eligibility—thanks to the federal government offering states financial incentives to not terminate Medicaid or CHIP coverage during the public health emergency.

Aditi Mallick, the CMS Office of Minority Health’s acting director, noted in an early December blog post that the disenrollments could disproportionately affect Black and Latino individuals, as estimates project that these groups could respectively account for 2.2 million and 4.6 million of the coverage terminations.

She cautioned that “without health coverage, people from racial and ethnic minority communities and other populations that are underserved could see a lapse in the progress they were able to make during the pandemic when Medicaid enrollment was continuous.”