News Release

Effects of the Medicaid “Unwinding” on Children


The newest update to KFF’s Medicaid enrollment tracker shows that as of August 23, at least 5,366,000 Medicaid enrollees have been disenrolled since states began the process of disenrolling people from Medicaid after a three-year pause during the Covid-19 pandemic, when people could not be kicked off the program. Across all states with available data, 74 percent of the people disenrolled had their coverage terminated for procedural reasons. This overall process could take more than a year. KFF’s update noted: “There is wide variation in disenrollment rates across reporting states, ranging from 72% in Texas to 8% in Wyoming.” 

    Gardner is a senior research associate at the Georgetown University McCourt School of Public Policy’s Center for Children and Families. 

There are also wide discrepancies in the number of procedural disenrollments between states. Gardner told the Institute for Public Accuracy: Some states began the process of Medicaid redeterminations right away, on April 1. “We see more disenrollments in [states like Arkansas, which started right away] than in a state of similar size like Georgia, which is a few months behind. Some states have also paused procedural disenrollments. This has been confused and conflated in news reports.”

 There are three types of pauses that states have undertaken. Some paused redeterminations prior to April 1. “As part of the preparation for the unwinding,” Gardner said, the Centers for Medicare and Medicaid Services (CMS) “worked with states on areas of deficiency where they weren’t in compliance with federal renewal requirements. One strategy was to pause disenrollments for particular groups.” Some states have voluntarily paused since April, while in others, CMS found the state “in violation of federal renewal requirements and made the state halt procedural disenrollments for some or all participants.”

But CMS has not released the names of all the states that have been forced to pause or have voluntarily paused. Gardner wants more transparency. 

She added: “We also want more data on what’s happening to kids. More states [are currently releasing data on children], but we’re not seeing the whole picture. Texas has released data [showing] that 500,000 people have been taken off of Medicaid. Four hundred thousand of those are kids. The data shows that kids are being impacted and that they’re the ones being procedurally disenrolled.” In other states, advocates “have no idea what’s happening… CMS is required to publicly release some data, but they’re doing it on a two to three month lag.” 

She went on: “Kids can be eligible for Medicaid or for the Child Health Insurance Program (CHIP). We would expect that CHIP numbers should increase [if a child is taken off of Medicaid]. We’re not seeing that. In some states, we’re actually seeing CHIP enrollment decline… and we’re not seeing them get to other coverage.” Those children may not be finding new coverage. 

“Kids are supposed to have between 14 and 15 well-baby visits according to the AAP [American Academy of Pediatrics] schedule. [Disenrollment creates] a lot of potential delays in care and in missed care.

“Patients have a 90-day reconsideration period, which allows families to turn in a renewal form after being disenrolled and get coverage renewed without having to go through a full application process, which can be onerous and full of red tape. But just because families have an opportunity to get back on doesn’t mean they are covered. Being terminated for coverage can still result in missed care or forgoing needed medication at point of service.

 “I can’t say that any state is holistically doing everything we would want a state to do. We’ve never seen anything like this before. Many states have antiquated systems and [are trying] to contact people who hadn’t been contacted in three years. It’s a heavy lift. But it’s hard to look at the numbers and feel that it’s worse than even what we expected.”