25 Million Lost Medicaid Coverage as States Resumed Eligibility Checks
More than 25 million people lost Medicaid coverage as states resumed eligibility checks after pandemic protections ended, with losses varying dramatically by state policies.
COLUMBUS, OHIO — More than 25 million people were disenrolled from Medicaid between April 2023 and mid-2025 as states resumed eligibility checks that had been paused during the COVID-19 pandemic, according to new data analyzing what health economists have termed the “Great Unwinding.”
The coverage losses followed a period of growth during the pandemic, when Medicaid enrollment reached an all-time high of more than 94 million people by early 2023. A federal policy of continuous coverage during the public health emergency had essentially halted Medicaid disenrollment, allowing the program to grow month after month in an unusual pattern for the government insurance program serving people with low incomes and disabilities.
Coverage losses varied dramatically across states, reflecting differences in how individual states conducted eligibility reviews and the administrative burden they placed on eligible people trying to maintain their enrollment, according to health policy researchers.
State Policy Differences Drive Uneven Coverage Losses
The fragmented, state-by-state results reveal how administrative policies shaped who retained coverage during the unwinding process. States that implemented more streamlined renewal processes and reduced paperwork barriers experienced lower disenrollment rates compared to those that maintained more complex administrative requirements.
Health economists studying the effects of public policy on insurance coverage have been tracking these enrollment shifts closely as the unwinding process has largely concluded. The data shows that coverage losses were not evenly distributed across the country, creating disparities in healthcare access that persist today.
Future Changes Loom for Medicaid Program
The patchwork of state policies implemented during the unwinding continues to have implications for current Medicaid recipients. Under the 2025 budget law, widely referred to as the One Big Beautiful Bill Act, states will face new requirements beginning January 1, 2027, that could further reshape Medicaid enrollment patterns.
The legislation represents another significant shift for the program that has experienced dramatic changes in enrollment over the past several years. From the pandemic-driven expansion to the subsequent mass disenrollment, Medicaid has undergone its most volatile period in the program’s history.
During the pandemic’s peak enrollment period, the unusual month-over-month growth pattern contrasted sharply with typical Medicaid enrollment fluctuations. The continuous coverage policy prevented the normal turnover that characterizes the program, creating a temporary safety net that helped millions maintain insurance during economic uncertainty.
The reversal that began in April 2023 marked an abrupt end to this period of stability. States faced the complex task of resuming eligibility determinations for tens of millions of beneficiaries while managing administrative backlogs that had accumulated during the pause.
The research findings highlight how state-level policy choices can significantly impact health insurance coverage for vulnerable populations, with effects that extend beyond the immediate enrollment numbers to influence long-term healthcare access and health outcomes across different communities.
