The Medicaid Unwinding: A Major Shift in Health Coverage

Between April 2023 and mid-2025, more than 25 million people were disenrolled from Medicaid and the Children's Health Insurance Program (CHIP).

This followed the conclusion of a federal policy that had paused routine eligibility checks during the COVID-19 pandemic. As of December 2025, total enrollment stands at approximately 76 million, which is above the pre-pandemic level of about 71 million but below the peak of roughly 94.1 million reached in 2023.

Background and Policy Change

Before the pandemic, Medicaid and CHIP covered about 71 million Americans. Enrollees were required to regularly renew their eligibility by confirming income and household information.

In March 2020, the Families First Coronavirus Response Act included a provision requiring states to keep most people continuously enrolled in Medicaid in exchange for enhanced federal funding. This policy, combined with pandemic-related job and income losses, contributed to an enrollment increase of approximately 23 million people, reaching a peak of about 94.1 million by early 2023.

Congress ended the continuous coverage requirement in late 2022, allowing states to restart eligibility reviews beginning April 1, 2023.

The "Great Unwinding" Disenrollment Process

The resumption of eligibility checks became known as the "Great Unwinding." By the time most states completed the process, more than 25 million people had been disenrolled, while about 56 million had their coverage renewed.

Data indicates that an estimated 69% of people who lost coverage were disenrolled for procedural reasons, such as failure to return renewal forms or outdated contact information, rather than a formal determination of ineligibility.

State-Level Administrative Variations

Coverage losses varied by state, reflecting differences in administrative approaches. Key state policies included:

• Automatic (Ex Parte) Renewals: The most common administrative tool, where states used existing government data to verify eligibility without requiring paperwork from beneficiaries. More than half of Medicaid renewals were completed automatically six months into the unwinding process. States that relied more heavily on this method had lower disenrollment rates.
• Other Mitigation Efforts: States also employed strategies such as extending renewal deadlines, adding staff to assist with renewals, and conducting outreach campaigns to update contact information.

Future Policy Requirements

The 2025 federal budget law introduces new requirements for states:

• States must begin checking eligibility for many adults every six months instead of once a year, starting from a date specified by the law.
• States must enforce new work requirements for many adults, with a start date of January 1, 2027, cited by multiple sources.
• The law also delayed the implementation of some federal changes intended to simplify Medicaid enrollment and renewal processes.

Analysts note that state-by-state differences in administrative processes are expected to continue influencing who maintains coverage under the new rules.