According to a new survey of state officials from the Kaiser Family Foundation (KFF), an estimated 15 million people may drop off Medicaid rolls over the next year as states redetermine program eligibility. That equates to an average disenrollment rate of 18%, higher than the 13% previously reported by states in 2022. While states had the option to initiate the first batch of Medicaid renewals in February, although unable to disenroll anyone before April 1, more than half of the states are waiting until April to begin the redetermination process. A majority of the reporting states in the survey plan to take at least 12 to 14 months to complete the redetermination process to avoid overwhelming agency resources and prevent administrative errors that could result in terminations of coverage for those who are still eligible for Medicaid. There are several state policies and actions outlined by KFF that states can use to promote continuity of coverage during the unwinding period, including streamlining renewals, improving outreach to Medicaid enrollees, increasing transparency around the redetermination process, and creating policies to increase Medicaid eligibility within the state.

The survey also acknowledges the unprecedented administrative burden the Medicaid unwinding will place on state agencies, many of whom are facing significant staffing shortages. Many of the reporting states have staff vacancies greater than 10% for eligibility workers and call center staff, forcing agencies to take steps to boost capacity. To address eligibility staffing shortages, agencies are approving overtime and hiring new staff, temporary workers, and contractors. As states prepare to implement their unwinding plans, the impact of the unwinding on Medicaid enrollees will vary from state to state. Unfortunately, research indicates that the uninsured rate is likely to increase as states begin the redetermination process. However, the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (DHS) is working with states to provide guidance on how to streamline eligibility and enrollment, promote access to coverage and improve quality of the Medicaid program.