Nearly one-quarter of adults booted from Medicaid are still uninsured, survey finds

Nearly a quarter of adults who said they were disenrolled from Medicaid coverage in the past year since states started resuming eligibility checks remain uninsured, according to a survey released Friday by KFF. 

The survey is the first to look at health coverage among adults who had Medicaid coverage in early 2023, just before states resumed eligibility checks and disenrollments after pandemic-era protections ended. 

It found that nearly half of those who were disenrolled eventually reenrolled in the program weeks or months later, suggesting their coverage was likely removed in error, likely because of reasons such as failure to submit required paperwork.

Jennifer Tolbert, a co-author of the KFF report and the director of KFF’s State Health Reform and Data Program, said it’s important for state policymakers to try to understand why so many people were removed who didn’t need to be.

“The one thing we do know that among people who are disenrolled, they are more likely to report skipping or delaying needed care than those who were able to easily renew their coverage,” Tolbert said.

“Was this someone who never got a renewal notice, so simply didn’t even know that they needed to take any action to maintain coverage? Or were these people who just … simply missed the deadline?”

Among those who were disenrolled, 28 percent found other forms of coverage, including 16 percent on employer-sponsored insurance, 9 percent on Medicare, and 8 percent who purchased their own insurance through the Affordable Care Act marketplace. 

But even going without coverage for a short period of time can lead people to delay needed care; 56 percent said they skipped or delayed getting health care services or prescriptions while attempting to renew their coverage.  

States that haven’t expanded Medicaid saw the biggest share of uninsured residents, but even in expansion states, 6 percent of preunwinding enrollees with household incomes of less than $20,000 — a group that should largely still be eligible for Medicaid — said they are currently uninsured. 

Seven in 10 adults who were disenrolled from Medicaid at any point during the unwinding process said that they became uninsured when they lost their Medicaid coverage. 

The survey interviewed a little more than 1,200 adults and found that about 1 in 5 said they had been disenrolled from Medicaid at some point in 2023. Since the unwinding process began, KFF estimates more than 20 million people have been kicked off Medicaid.

That number is likely to grow. States have a year to complete the process, and some started later than others.  

The survey didn’t include children, so Tolbert said the findings can’t be used to determine how the Medicaid unwinding has affected the overall U.S. uninsured rate. Still, she said there have been “unexpectedly high coverage losses among children.”

Before the pandemic, people churned in and out of Medicaid for various reasons. Participants lost their coverage if they earned too much or didn’t provide the information needed to verify their income or residency.  

But during the public health emergency period, income changes or missed paperwork didn’t matter. As a result, Medicaid enrollment grew more than 30 percent and covered more than 90 million people.   

But Congress ended those protections, and states have been able to reassess eligibility and remove people off Medicaid rolls since April 2023.  

The survey found people sometimes had little knowledge that they were being disenrolled. Nearly 1 in 3 disenrolled adults found out they lost coverage only when they sought health care, like going to a doctor or a pharmacy. 

The KFF survey of 1,227 adults who had Medicaid coverage in early 2023 prior to the start of the unwinding on April 1, 2023, was conducted between Feb. 15 and March 11. The margin of sampling error was 4 percentage points. 

Updated at 3:37 p.m.