The federal COVID-19 public health emergency expired on May 11, 2023, but the date that mattered most for Medicaid was actually March 31, 2023. That’s when the continuous enrollment provision ended, allowing states to begin removing people from Medicaid rolls for the first time in three years. The massive review process that followed, known as “unwinding,” stretched well into 2024 and resulted in more than 20 million people losing coverage.
Two Dates That Matter
During the pandemic, Congress attached a condition to the extra federal funding states received for Medicaid: states could not drop anyone from coverage. This “continuous enrollment” rule kept people on Medicaid even if their income changed or they moved to a different state. It was the largest expansion of Medicaid enrollment in the program’s history.
The continuous enrollment provision was originally tied to the public health emergency, but Congress separated the two timelines in late 2022 through the Consolidated Appropriations Act. That law set a firm end date of March 31, 2023, for continuous enrollment, regardless of what happened with the broader emergency declaration. The public health emergency itself ran until May 11, 2023, but by that point states had already begun reviewing whether each enrollee still qualified for coverage.
What “Unwinding” Looked Like
Starting April 1, 2023, every state had to work through its entire Medicaid caseload and redetermine eligibility for each person enrolled. States had up to 14 months to complete this process, and the federal government tracked their progress on a rolling basis. Some states moved quickly: Idaho, Montana, New Hampshire, Oklahoma, and South Dakota finished by March 2024. Others took much longer. North Carolina wasn’t scheduled to finish until November 2024, and Alaska and Washington, D.C. had timelines extending into 2025.
The sheer scale was staggering. Between April 2023 and June 2024, states processed renewals for roughly 75.8 million people. Of those, 55.1 million had their coverage renewed. The remaining 20.7 million, about 22% of those reviewed, lost their Medicaid coverage.
Most People Lost Coverage for Paperwork Reasons
Here’s the number that drew the most criticism: of the 20.7 million people who lost coverage, nearly 14.3 million (about 69% of all terminations) were dropped for procedural reasons rather than confirmed ineligibility. That means they didn’t return a form, didn’t respond to a letter, or had outdated contact information on file. Only 6.5 million were actually determined to no longer qualify based on income or other eligibility criteria.
Procedural denial rates varied wildly by state. Some states denied fewer than 1 in 100 renewals on procedural grounds, while others denied more than 1 in 4. States that relied heavily on automated renewal systems actually had higher procedural denial rates (a median of 11.1%) compared to states with less automation (a median of 3.5%), likely because automated systems flagged incomplete records without human follow-up.
Children were hit particularly hard. Net Medicaid enrollment dropped by about 5.5 million children during the unwinding period, a 13.8% decline. Many of these children likely still qualified for Medicaid or CHIP but fell through the cracks when their parents missed renewal deadlines.
Options if You Lost Medicaid Coverage
If you were disenrolled during unwinding, you had a special window to sign up for health insurance through HealthCare.gov or your state’s marketplace. This temporary special enrollment period ran from March 31, 2023, through November 30, 2024, and gave people 60 days after submitting or updating an application to select a marketplace plan. Coverage started the first day of the month after plan selection. Some states offered 90 days or longer to choose a plan, matching their Medicaid reconsideration periods.
If you were dropped for procedural reasons and believe you still qualify, you can reapply for Medicaid at any time. There is no limit on how often you can apply, and many people who were terminated for missing paperwork are still income-eligible. Contact your state Medicaid office or visit HealthCare.gov to start a new application. If your income has increased since you first enrolled, marketplace plans with premium subsidies may be available depending on your household size and earnings.
What Medicaid Renewals Look Like Now
With the unwinding period over in most states, Medicaid has returned to its standard renewal cycle. That means your eligibility is reviewed once a year, typically on the anniversary of your enrollment or last renewal. Your state Medicaid agency will send you a renewal packet by mail, and in many states you can also complete the process online or by phone. If your state can verify your eligibility using existing data sources like tax records, your renewal may happen automatically without any action on your part.
The key difference from the pandemic era is simple: if you don’t respond to a renewal notice or your information can’t be verified, your coverage will end. Keeping your mailing address and contact information current with your state Medicaid office is the single most important thing you can do to avoid a gap in coverage.