Discover the key points you need to know about the unwinding of the Medicaid continuous enrollment provision. Learn how millions may lose coverage, state approaches, outreach strategies, and the impact on health insurance rates.

Navigating the Unwinding of Medicaid Continuous Enrollment: 10 Crucial Facts


The COVID-19 pandemic brought about significant changes in healthcare policies, including the introduction of the Medicaid continuous enrollment provision. This provision ensured that Medicaid enrollees had continuous coverage throughout the pandemic, providing a safety net during uncertain times. However, as the pandemic’s effects subside, the unwinding of this provision poses new challenges for millions of people who relied on Medicaid. In this blog, we’ll delve into ten essential facts you need to know about the unwinding of the Medicaid continuous enrollment provision and its potential impact on healthcare coverage.

Navigating the Unwinding of Medicaid Continuous Enrollment: 10 Crucial Facts

1. Increase in Medicaid Enrollment

Since the start of the pandemic, Medicaid enrollment has surged significantly, primarily due to the continuous enrollment provision. According to estimates by KFF (Kaiser Family Foundation), Medicaid/CHIP enrollment grew by approximately 23.3 million to nearly 95 million from February 2020 to March 2023 when the continuous enrollment provision ended. This provision, included in the Families First Coronavirus Response Act (FFCRA), required states to provide continuous coverage for Medicaid enrollees to receive enhanced federal funding, thus preserving coverage during the pandemic.

2. Projected Coverage Losses

As the unwinding of the continuous enrollment provision proceeds, KFF estimates that between 7.8 million and 24.4 million people could lose Medicaid coverage during the 12-month period, representing an 8% to 28% decline in enrollment. The number of people disenrolled across states will vary, but it is expected that groups that benefited the most from the continuous enrollment provision, such as ACA expansion adults, other adults, and children, will face the largest enrollment declines.

3. Halt of Medicaid Churn

The continuous enrollment provision effectively stopped “churn” among Medicaid enrollees, a temporary loss of coverage that often occurs due to short-term changes in income or procedural issues. This provision played a crucial role in ensuring access to healthcare during the pandemic.

4. State Approaches to Unwinding

States have adopted diverse approaches to unwinding the continuous enrollment provision. CMS (Centers for Medicare and Medicaid Services) requires states to submit renewal redistribution plans detailing their strategies to minimize coverage losses. The timing of resuming disenrollments and the duration of the unwinding period varies among states.

5. Streamlined Renewal Processes

Maximizing streamlined renewal processes can promote continuity of coverage during the unwinding. Completing renewals using electronic data sources to verify ongoing eligibility reduces the burden on enrollees. CMS guidance allows states to expand data sources for verification, reducing the need for enrollee follow-ups.

6. Temporary Waivers

States can obtain temporary waivers to support their unwinding plans, aiming to reduce operational challenges related to staffing and outdated systems. These waivers facilitate the renewal process and minimize procedural terminations.

7. Vulnerable Groups

Certain groups may face higher risks of losing Medicaid coverage during the unwinding. People who have moved, immigrants with limited English proficiency, people with disabilities, and older adults may encounter barriers during the renewal process.

8. Partnering for Outreach

States can collaborate with managed care organizations (MCOs), community health centers, and other partners to conduct outreach, update enrollee contact information, and assist with the renewal process.

9. Monitoring the Unwinding

Timely data on disenrollments and other metrics are crucial for monitoring the unwinding process effectively. States are required to report data on renewals and disenrollments, helping identify potential challenges.

10. Potential Increase in Uninsured Individuals

As Medicaid disenrollments occur, the number of people without health insurance could rise. Strategies to ease transitions from Medicaid to other coverage programs can mitigate coverage losses.

Navigating the Unwinding of Medicaid Continuous Enrollment: 10 Crucial Facts


The unwinding of the Medicaid continuous enrollment provision presents both challenges and opportunities for state healthcare systems. As millions potentially lose coverage, it’s essential to prioritize outreach efforts, streamline renewal processes, and monitor the effects of these changes closely. By understanding the ten crucial facts outlined in this blog, policymakers and healthcare providers can work together to ensure continued access to healthcare for vulnerable populations and maintain progress made in healthcare coverage during the pandemic.

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