This report provides current HHS projections of the number of individuals predicted to lose Medicaid coverage at the end of the COVID-19 public health emergency (PHE) due to a change in eligibility or due to administrative churning. The report also predicts eligibility for alternative insurance coverage among those predicted to lose Medicaid eligibility and highlights legislative and administrative actions that can help minimize disruptions in coverage, including the passage of the Inflation Reduction Act, which provides enhanced Marketplace subsidies for 3 years that will benefit some individuals leaving Medicaid at the end of the PHE.
• After expiration of the COVID-19 public health emergency (PHE), Medicaid’s continuous enrollment provision will come to an end. Using longitudinal survey data and 2021 enrollment information, we currently project that 17.4 percent of Medicaid and Children’s Health Insurance Program (CHIP) enrollees (approximately 15 million individuals) will leave the program based on historical patterns of coverage loss.
• Approximately 9.5 percent of Medicaid enrollees (8.2 million) will leave Medicaid due to loss of eligibility and will need to transition to another source of coverage. Based on historical patterns, 7.9 percent (6.8 million) will lose Medicaid coverage despite still being eligible (“administrative churning”), although HHS is taking steps to reduce this outcome.
• Children and young adults will be impacted disproportionately, with 5.3 million children and 4.7 million adults ages 18-34 predicted to lose Medicaid/CHIP coverage. Nearly one-third of those predicted to lose coverage are Latino (4.6 million) and 15 percent (2.2 million) are Black.
• Almost one-third (2.7 million) of those predicted to lose eligibility are expected to qualify for Marketplace premium tax credits. Among these individuals, over 60 percent (1.7 million) are expected to be eligible for zero-premium Marketplace plans under the provisions of the American Rescue Plan (ARP). Another 5 million would be expected to obtain other coverage, primarily employer-sponsored insurance.
• An estimated 383,000 individuals projected to lose eligibility for Medicaid would fall in the coverage gap in the remaining 12 non-expansion states – with incomes too high for Medicaid, but too low to receive Marketplace tax credits. State adoption of Medicaid expansion in these states is a key tool to mitigate potential coverage loss at the end of the PHE.
• States are directly responsible for eligibility redeterminations, while CMS provides technical assistance and oversight of compliance with Medicaid regulations. Eligibility and renewal systems, staffing capacity, and investment in end-of-PHE preparedness vary across states. HHS is working with states to facilitate enrollment in alternative sources of health coverage and minimize administrative churning. These efforts could reduce the number of eligible people losing Medicaid compared to the estimates above.
• The Inflation Reduction Act of 2022 extends the ARP’s enhanced and expanded Marketplace premium tax credit provisions until 2025, providing a key source of alternative coverage for those losing Medicaid eligibility.