1.6M Dually Enrolled in Medicaid, Medicare Have Lost Coverage During Unwinding
New NORC research analyzes the impact of Medicaid redeterminations on dual eligibles.
CHICAGO, November 18, 2024 — Following the pandemic, 9.4 million people enrolled in Medicare and Medicaid risked losing their Medicaid coverage. According to new research from NORC at the University of Chicago and supported by AHIP, these individuals, known as dual eligibles, experienced significant coverage losses.
NORC analyzed Medicare enrollment data from April 2023 to June 2024 to understand the impact of the Medicaid unwinding process on dual eligibles. Researchers looked at coverage loss and the extent to which these people who lost their Medicaid status during the unwinding period returned to Medicaid—a concept known as churn—during the study period.
Our groundbreaking analysis revealed that:
- Over 1.6 million dual eligibles lost full Medicaid coverage since the unwinding period began in April 2023. This represents over 17 percent of full duals enrolled prior to redeterminations. The percentage of duals experiencing coverage loss varies by state, ranging from 6 percent in New York and Alabama to 53 percent in Utah. By comparison, 27 percent of the full Medicaid population (including dual eligibles) lost Medicaid coverage during the same period.
- So far during the redeterminations period, 2.1 percent of duals who lost coverage have re-enrolled in Medicaid, a process known as churn. The percentage of dual eligibles who lost coverage experiencing churn varies by state, ranging from less than 1 percent in Alabama to approximately 6 percent in North Dakota and Utah. Historically, most churn for dual eligibles has been for administrative reasons, meaning they could still be eligible for coverage. A low churn rate combined with high administrative disenrollments could mean eligible individuals remain disenrolled.
“Before our analysis, there were limited data on the impact of the Medicaid unwinding process on vulnerable Medicaid populations, including dual eligibles.”
“Before our analysis, there were limited data on the impact of the Medicaid unwinding process on vulnerable Medicaid populations, including dual eligibles,” said Kate Honsberger, director of Health Care Strategy at NORC. “This new research, the first of its kind to our knowledge, shines a light on the disruptions to coverage that can occur, resulting in high out-of-pocket costs and barriers to necessary care.”
Medicaid is an important source of health coverage for this population, covering 9.4 million dual eligibles enrolled in full Medicaid benefits as of March 2023. Duals with full Medicaid coverage are at risk of losing access to Medicaid services not covered by Medicare, including home and community based services (HCBS) such as long-term nursing care.
Methodology
For this analysis, we used Medicare enrollment data through the Medicare Master Beneficiary Summary Base (A/B/C/D) File (MBSF). The study period, as defined for this analysis, runs from April 2023 through June 2024. The analyzed population consisted of individuals dually enrolled in Medicare and full Medicaid as of March 2023. We excluded partial duals, i.e., beneficiaries only enrolled in Medicare Savings Programs. Due to concerns about data suppression or unknown variables, we excluded all people under 19 and those with unknown state of residence or unknown sex.
About NORC at the University of Chicago
NORC at the University of Chicago conducts research and analysis that decision-makers trust. As a nonpartisan research organization and a pioneer in measuring and understanding the world, we have studied almost every aspect of the human experience and every major news event for more than eight decades. Today, we partner with government, corporate, and nonprofit clients around the world to provide the objectivity and expertise necessary to inform the critical decisions facing society.
Contact: For more information, please contact Eric Young at NORC at young-eric@norc.org or (703) 217-6814 (cell).
About AHIP
AHIP is the national association whose members provide health care coverage, services, and solutions to hundreds of millions of Americans every day. We are committed to market-based solutions and public-private partnerships that make health care better and coverage more affordable and accessible for everyone.
