Since the rollback of COVID-era healthcare regulations began in spring 2023, nearly every state in the US has recorded a decrease in Medicaid registrations. The only state to show an increase in sign-ups between March 2023 and January 2025 is North Carolina, while South Dakota’s Medicaid enrollment has remained stable on average.
Why is it important?
During the pandemic, federal healthcare support expanded, keeping many enrollees in the Medicaid program. However, states have now started a process to reassess and review eligibility, which has resulted in many people being removed from the program since March 2023. This drop in enrollment could be caused by various factors—like changes in income, or perhaps errors in documentation, missed deadlines, or outdated contact information.
Health professionals are sounding alarms about how this unwinding process could adversely affect some of the most at-risk groups in the country. Potential repercussions include poorer health outcomes, higher emergency care costs, and numerous other challenges.
What do you know
The decline in Medicaid registrations has varied from state to state between March 2023 and January 2025. For instance, Montana has experienced the steepest drop, with a 37% reduction in Medicaid registrations. Other states, such as Texas, Colorado, and Utah, have also seen a decline of over 30% during the same time frame.
Conversely, California and Oregon have shown smaller fluctuations in their Medicaid coverage. Although most states are witnessing falling registration numbers since spring 2023, many still haven’t reached levels prior to the pandemic.
This unwinding has led to millions losing Medicaid benefits across the nation, amounting to about 16 million individuals between March 2023 and January 2025.
What people are saying
Paul Schafer, a professor specializing in health law and policy at Boston University, mentioned to Newsweek: “As almost every state had finished the rewinding process by the end of 2024, there are worries about a continued decline, especially if it speeds up soon. The data on uninsured rates has lagged behind, moving from 7.7 to 8.5% between mid-2023 and September 2024. Coverage losses may begin if proposed Medicaid reductions in a major legislation are enacted.”
He further noted, “Losing health insurance can have immediate and long-lasting effects, ranging from delayed medical care to severe health issues that can lead to higher mortality. The health needs of these individuals will persist, and the ensuing backlog may worsen. Since Medicaid reimbursements are usually higher than others, if they face cuts, it will affect not just those enrolled, but the broader system.”
What will happen next
As new policies are still in development and debate in Congress, adjustments and eligibility criteria for the Medicaid program are expected to be introduced. The Congressional Budget Office projects that by 2034, over 13 million Americans could lose their Medicaid coverage.
