The Range for Projected, Post-PHE Medicaid Disenrollment Is Broad

April 27, 2023 - Depending on the Medicaid disenrollment rate after the public health emergency, the public payer program could lose anywhere from 8 million to over 24 million Medicaid enrollees, a Kaiser Family Foundation (KFF) analysis indicated.

The researchers relied on the T-MSIS Research Identifiable Demographic-Eligibility (T-MSIS data) as well as CMS Performance Indicator Project Data (PI data). They noted that the data might be distinct from state-based data because they assessed eligibility for children based on age and because they did not include enrollee populations that are not eligible for full Medicaid coverage.

“Our estimates are based on the best available public data on states’ Medicaid enrollment, but predicting the future here with incomplete data is highly uncertain and the scenarios described in this data note are intended to be illustrative only,” the researchers stated.

The authors added that the number of people who lose coverage will be higher than the shifts in Medicaid enrollment because some individuals will quickly re-enroll in addition to new enrollees. The timeframe for this analysis was between March 2023 and May 2024.

Around 17 million individuals—or 18 percent of Medicaid enrollment across all states—could lose Medicaid coverage during the analysis’s timeframe. In this projection, 5 million of the disenrolled individuals would be children.

The actual numbers could be as low as 7.8 million or as high as 24.4 million, depending on various factors.

The lower end of the projected disenrollment statistics reflects an eight percent disenrollment rate with 2.2 million children losing Medicaid coverage along with 5.6 million adults. The higher end of the spectrum projects the results of a 28 percent disenrollment rate with 7.2 million children disenrolled from Medicaid as well as 17.2 million adults.

“While neither the lowest nor highest rate of disenrollment is an expected national outcome, the range may be helpful in examining what the variation could be across states,” the press release explained.

In the context of the massive enrollment gains that the Medicaid program experienced during the coronavirus pandemic, the program could lose half of those pandemic-era enrollees between March 2023 and May 2024 or more.

One mid-level estimate showed that Medicaid enrollment would remain higher than before the public health emergency. However, the Medicaid program could lose around 75 percent of the pandemic-era enrollment gains. In some states, contemporary losses might surpass the historic gains from the pandemic.

California, New York, and Texas were expected to see the highest rates of coverage loss. If the mid-range, 18 percent disenrollment rate proves true, these three states could see 2.6 million, 1.4 million, and over 833,000 enrollees lose Medicaid coverage, respectively.

The states with the lowest total disenrollment levels in the mid-range scenario (18 percent disenrollment rate) would be Wyoming, South Dakota, and North Dakota. All of these would see less than 25,000 enrollees leave their Medicaid programs.

While KFF offered these estimates for state-by-state disenrollment levels across three different scenarios, they noted that only a third of states could provide a projection for Medicaid coverage losses post-public health emergency.

States have been preparing for the redetermination process to restart. For example, in April 2023, Massachusetts released its multi-pronged approach for reducing coverage loss during redetermination.

The results of past redetermination processes, pre-pandemic, have given experts cause for concern. One study indicated that more than half of all disenrolled Minnesota Medicaid beneficiaries between January 1, 2018 and February 28, 2019 were uninsured after disenrollment.

While there are steps states can take to prepare for redeterminations, coverage losses are projected to be high.