Nearly 2 Million Adults Ages 50 to 64 Are Losing Medicaid Coverage from Postpandemic Disenrollments

The Medicaid redetermination process requires states to evaluate program enrollees once a year to determine if they are still eligible for the program. A pause in redeterminations came in April 2020, when federal law required states to halt Medicaid disenrollments (providing “continuous enrollment”) to help ensure medical access and care during the COVID-19 pandemic. Medicaid enrollment subsequently grew to historic highs, and the overall uninsured rate dropped to historic lows.

In April 2023, the redetermination pause ended. As of August 2024, most Medicaid enrollees had completed an eligibility redetermination as part of the process often referred to as “unwinding” the continuous enrollment.

Modeling by NORC at the University of Chicago done in collaboration with the AARP Public Policy Institute estimates that about 1.9 million people ages 50 to 64 will have lost Medicaid coverage by the end of August 2024 as a result of the redetermination process. Although some individuals are disenrolled because they are no longer eligible, most of those disenrolled are losing Medicaid merely for administrative reasons, such as failure to receive the renewal packet or complete the paperwork on time, despite potentially still being fully qualified for Medicaid coverage. 

This paper discusses the Medicaid redetermination process, explores national and state-by-state estimates on disenrollments from NORC’s analysis, and examines policy implications for upcoming Medicaid enrollment. The past year of redeterminations has illuminated many preexisting problems with the process and has seen new ones arise.

See the report for detailed Medicaid enrollment and change data for every state and DC. 

Key Takeaways

• Lifting the pandemic pause on Medicaid redeterminations is resulting in almost 2 million people ages 50 to 64 losing Medicaid.
• Administrative factors are a major source of these disenrollments, causing automatic disenrollments for many people who may still be fully eligible for Medicaid.
• Coverage disruptions, even if temporary, can have an outsized impact on those ages 50 to 64 due to higher health risks in this group.  Future research will help policymakers understand how many of those who lost Medicaid either gained coverage through other sources, re-enrolled in Medicaid, or became uninsured.
• States have initiated process improvements to make redeterminations run smoother. These improvements should continue, and new federal rules will help.

Several factors have contributed to the high number of disenrollments from administrative issues. Specifically, state and federal policymakers, along with the state programs themselves, faced many significant challenges leading up to the start of the unwinding and disenrollment process, including record enrollment during the pandemic, outreach challenges alerting enrollees to redeterminations, and existing gaps and inefficiencies in the process. Recognizing these challenges, the Centers for Medicare & Medicaid Services (CMS) offered states many flexibilities to help the process run more smoothly.

Although states and the federal government have worked to make improvements, more are needed to ensure that enrollment is based on eligibility rather than administrative challenges. Medicaid continues to be an essential source of health care coverage for many ages 50 to 64. NORC models project that about 8.7 million people ages 50 to 64 will rely on Medicaid once the unwinding redeterminations are completed, an increase of 6.5 percent from enrollment before the freeze in 2020 and in line with prepandemic growth rates for Medicaid enrollment over time.

People ages 50 to 64 face an increased risk of age-related health problems and chronic conditions that make losing health coverage particularly concerning. For the millions of people with low incomes being disenrolled from Medicaid, maintaining their access to health insurance—either through other sources or through efficient renewal of their Medicaid coverage—is an important policy issue.