Millions of people lost Medicaid coverage during the post-pandemic redeterminations period.

As the health insurance program for low-income people in the U.S., including families and children, pregnant and post-partum individuals, the disabled, and the elderly, Medicaid provides health care coverage to millions of people. The program is run jointly by states and the federal government, and policies vary by state.

In general, Medicaid enrollees are required to verify their eligibility for the program each year. During the COVID-19 pandemic and ensuing public health emergency, the federal government allowed states to suspend this requirement. As a result, enrollees were able to stay on Medicaid, and overall enrollment in Medicaid increased. Starting in April 2023, the federal government required states to redetermine eligibility of all individuals enrolled in Medicaid. This is referred to as the “unwinding” of the continuous enrollment requirement, or Medicaid redeterminations.

The unwinding is a complex operational and policy challenge for state Medicaid agencies, managed care organizations, individuals enrolled in Medicaid, and those that support them.

NORC provided strategic direction, as well as policy and data analysis, to clients seeking to understand the Medicaid redeterminations period and its impact.

NORC worked with several clients, including AARP Public Policy Institute and AHIP, to develop tailored solutions to help them understand and adapt to the Medicaid unwinding. Our work included:

• Developing projection models to understand the potential impact of Medicaid redeterminations on specific outcomes (e.g., transitions to other coverage) and populations (e.g., older adults)
• Data analysis of state Medicaid data across multiple sources, including Centers for Medicare & Medicaid Services (CMS), KFF, Georgetown Center of Children and Families, and state Medicaid unwinding dashboards
• Novel analyses examining associations between specific state redetermination policies and renewal outcomes such as correlation between ex parte renewal rate and procedural termination rate
• Tracking, analyzing, and summarizing CMS and state policy updates related to Medicaid redeterminations, producing various ad hoc, time-sensitive deliverables

Our research continues to demonstrate the impact of Medicaid redeterminations on health care policy and health outcomes across the country.

For AARP Public Policy Institute, NORC predicted the impact of the ongoing Medicaid redeterminations on enrollment of older adults aged 50-64 and dually eligible beneficiaries,  modeling that over 1 million adults 50-64 could lose Medicaid coverage. In work for AHIP ahead of the Medicaid redetermination process, NORC produced state-level estimates of coverage transitions that Medicaid enrollees would make after losing Medicaid coverage: to employer-sponsored insurance (ESI), CHIP, Marketplace, other coverage, or becoming uninsured. Our modeling predicted that in nearly all states, the majority of individuals will transition to employer-provided coverage (EPC).

NORC continues to support other clients in ongoing work related to Medicaid redeterminations.