Here are the 8 states where Medicaid disenrollments far exceeded projections

By Noah Tong / May 2, 2024

Two new studies released Thursday shed new light on how states are handling the Medicaid unwinding process for adults and children.

Using monthly enrollment reports, a Robert Wood Johnson Foundation-funded Urban Institute report found Medicaid and Children’s Health Insurance Program (CHIP) enrollment declined by 9 million people from April through November 2023. Although this is on pace with previous Urban Institute projections, different states are seeing drastically different impacts.

Eight states had Medicaid disenrollments exceeding 100% of the think tank’s projected net disenrollments. Those eight states are Arkansas, Idaho, Iowa, Montana, New Hampshire, Oklahoma, South Dakota and Texas.

Children unenrolled at a far higher clip than adults nationwide, meeting 84.2% of the Urban Institute’s prior projections. This was driven by 12 states: Alabama, Arkansas, Colorado, Florida, Georgia, Idaho, Iowa, Mississippi, Montana, Oklahoma, South Dakota and Texas.

“As of November 2023, some states had disenrolled more people than we had projected for the entire unwinding, suggesting that overall disenrollment could be even greater than anticipated,” the authors said in the report.

They found states that completed redeterminations in less than 12 months and obtained fewer federal waivers were more likely to perform worse than other states.

“While Medicaid redeterminations are not yet complete, these early data points are consistent with projections that a seismic coverage shift is underway,” said Kathy Hempstead, senior policy adviser at the Robert Wood Johnson Foundation, in a statement.

Losing Medicaid or CHIP coverage has shown to lead to worse health outcomes. The redetermination process, following the end of the public health emergency for the COVID-19 pandemic, is a priority and point of concern for the Biden administration, and states have not agreed on how to best handle the crisis.

Another study, this time released by the Georgetown University McCourt School of Public Policy, revealed 4.16 million fewer children are enrolled in Medicaid and CHIP than before the PHE, as of December 2023. It notes that many of those children are likely still eligible for Medicaid.

Four states accounted for approximately half of those disenrollees: Texas (at 1 million impacted children), followed by Florida, Georgia and California. In Texas, 1 in 5 fewer children are enrolled in Medicaid or CHIP programs.

By percentage decline, South Dakota, Montana and Utah lead the way. Those three states have 25% less children enrolled than at the beginning of redeterminations.

Eight states now have less children enrolled than they did prior to the COVID-19 pandemic: Alaska, Arkansas, Colorado, Idaho, Montana, New Hampshire, South Dakota and Utah.

For example, Montana had 114,894 enrollees in February 2020. By December 2023, it had just 97,856 enrollees, a 15% decrease.

“This is a troubling finding given that all but one of these states had relatively low participation rates of eligible children covered by Medicaid/CHIP prior to the pandemic—suggesting that red tape barriers are likely resulting in high rates of children becoming uninsured,” the Georgetown University authors said.

Some have hoped that Medicaid disenrollment would lead to CHIP enrollment, as individuals would transition to different coverage. Both reports say evidence does not point in that direction because nationwide CHIP enrollment has only increased minimally.

“When comparing Medicaid child enrollment losses to separate CHIP enrollment growth, we found that only 10.3% of Medicaid enrollment declines were offset by CHIP gains,” the Georgetown University authors said.