Overall enrollment increases reflect economic conditions related to the pandemic, the adoption of the Medicaid expansion under the Affordable Care Act in several states (NE, MO, OK), as well as the continuous enrollment provision included in the FFCRA. KFF estimates that enrollment in Medicaid/CHIP will have grown by 23.3 million to nearly 95 million from February 2020 to the end of March 2023 when the continuous enrollment provision ended (Figure 1). Medicaid enrollment has increased since the start of the pandemic, primarily due to the continuous enrollment provision.
This brief describes 10 key points about the unwinding of the Medicaid continuous enrollment provision, highlighting data and analyses that can inform the unwinding process as well as legislation and guidance issued by the Centers for Medicare and Medicaid Services (CMS) that lay out the rules states must follow during the unwinding period and the flexibilities available to them. States can resume disenrollments beginning in April but must meet certain requirements to be eligible for enhanced federal funding during the unwinding. But, as states resume disenrollments following the end of the continuous enrollment provision, millions of people could lose coverage and that could reverse recent gains in coverage. Primarily due to the continuous enrollment provision, Medicaid enrollment has grown substantially compared to before the pandemic and the uninsured rate has dropped. The CAA also phases down the enhanced federal Medicaid matching funds through December 2023. As part of the Consolidated Appropriations Act, 2023, signed into law on December 29, 2022, Congress delinked the continuous enrollment provision from the PHE, ending continuous enrollment on March 31, 2023. The number of people without health insurance could increase if people who lose Medicaid coverage are unable to transition to other coverage.Īt the start of the pandemic, Congress enacted the Families First Coronavirus Response Act (FFCRA), which included a provision that Medicaid programs keep people continuously enrolled through the end of the COVID-19 public health emergency (PHE), in exchange for enhanced federal funding.Timely data on disenrollments and other metrics will be useful for monitoring how the unwinding is proceeding.States can partner with MCOs, community health centers, and other partners to conduct outreach.Certain groups may be at greater risk for losing Medicaid coverage during the unwinding period.States can obtain temporary waivers to pursue strategies to support their unwinding plans.
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