10 Things to Know About the Unwinding of the Medicaid Continuous Enrollment Provision

Note: This brief was updated April 5, 2023, to include more recent and additional data.

  1. Medicaid enrollment has increased since the start of the pandemic, primarily due to the continuous enrollment provision.
  2. KFF estimates that between 5 million and 14 million people will lose Medicaid coverage during the unwinding of the continuous enrollment provision.
  3. The Medicaid continuous enrollment provision has stopped “churn” among Medicaid enrollees.
  4. States have developed plans for how they will approach the unwinding of the continuous enrollment provision.
  5. Maximizing streamlined renewal processes can promote continuity of coverage as states begin to unwind the continuous enrollment provision.
  6. States can obtain temporary waivers to pursue strategies to support their unwinding plans.
  7. Certain groups may be at greater risk for losing Medicaid coverage during the unwinding period.
  8. States can partner with MCOs, community health centers, and other partners to conduct outreach.
  9. Timely data on disenrollments and other metrics will be useful for monitoring how the unwinding is proceeding.
  10. The number of people without health insurance could increase if people who lose Medicaid coverage are unable to transition to other coverage.

At 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. 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 CAA also phases down the enhanced federal Medicaid matching funds through December 2023. Primarily due to the continuous enrollment provision, Medicaid enrollment has grown substantially compared to before the pandemic and the uninsured rate has dropped. 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. States can resume disenrollments beginning in April but must meet certain requirements to be eligible for enhanced federal funding during the unwinding.

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

Read More