Skip to main content

Advanced Search

Advanced Search

Current Filters

Filter your query

Publication Types

Other

to

Mirror, Mirror 2024 is your opportunity to explore the impact of policy choices on health and well-being across 10 countries, including the U.S. Read the report here.

Area of Focus

Achieving Universal Coverage

Issue Briefs

/

Reducing Medicaid Churn: Policies to Promote Stable Health Coverage and Access to Care

Two doctors talk to patient in clinic

Alejandra Duran Arreola, a second-year medical student who intends to practice obstetrics and gynecology, works as a translator for Dr. Matt Steinberger at the Access to Care clinic at the Loyola Center for Health in Chicago. Evidence shows that people with Medicaid coverage have better health outcomes, fewer hospitalizations and emergency room visits, and lower mortality rates than people without any coverage. Photo: Alyssa Schukar for the Washington Post via Getty Images

Alejandra Duran Arreola, a second-year medical student who intends to practice obstetrics and gynecology, works as a translator for Dr. Matt Steinberger at the Access to Care clinic at the Loyola Center for Health in Chicago. Evidence shows that people with Medicaid coverage have better health outcomes, fewer hospitalizations and emergency room visits, and lower mortality rates than people without any coverage. Photo: Alyssa Schukar for the Washington Post via Getty Images

Toplines

  • When Medicaid beneficiaries lose coverage and later reenroll, individuals temporarily lose access to care and states face greater administrative burdens

  • Policymakers have several options to reduce churn in Medicaid enrollment, including expanding continuous eligibility and assisting people during coverage renewals

Toplines

  • When Medicaid beneficiaries lose coverage and later reenroll, individuals temporarily lose access to care and states face greater administrative burdens

  • Policymakers have several options to reduce churn in Medicaid enrollment, including expanding continuous eligibility and assisting people during coverage renewals

Authors
MaryBeth Musumeci, Caitlin Murphy, Elizabeth Leiser, Hannah Silverman, Kian Azimpoor
Downloads
RELATED CONTENT

Abstract

  • Issue: Enrollment churn is common in Medicaid; one in 10 enrollees lose and regain coverage within 12 months. Churn disrupts people’s access to health care and creates administrative burden and cost for states.
  • Goal: Identify potential federal policy actions to reduce Medicaid enrollment churn and improve continuity of coverage.
  • Methods: Scan of state policy databases to identify approaches to reducing Medicaid churn; literature review to evaluate the effects of states’ approaches on churn, administrative burden, and cost.
  • Key Findings: Providing uninterrupted Medicaid coverage for at least 12 months significantly reduces churn, states’ administrative burden, and cost to states and patients. Continuous eligibility is also associated with improved health care access and outcomes. Other strategies to reduce churn include automated coverage renewals, outreach to prevent procedural disenrollments, and in-person assistance with coverage renewals and transitions.
  • Conclusion: Congress has options for reducing Medicaid churn: adopt 12-month continuous eligibility for adults; approve a state plan option for multiyear continuous eligibility for children; adopt new requirements to increase automated renewals; and increase federal funding to expand in-person assistance. Policies included in the House budget reconciliation bill, however, would increase churn, e.g., by requiring eligibility renewal every six months instead of every year for adults covered under Medicaid expansion.

Introduction

Medicaid is an essential source of health coverage for one in five Americans, providing access to care for low-income families, communities of color, people with disabilities, and other underserved populations.1 Evidence shows that people with Medicaid coverage have better health outcomes, fewer hospitalizations and emergency room (ER) visits, and lower mortality rates than people without any coverage.2

Medicaid enrollment “churn” occurs when enrollees lose and regain coverage over the course of a year. Unfortunately, churn is common in Medicaid: the typical enrollee is covered for less than 10 months, and 10 percent of enrollees lose and regain Medicaid within 12 months.3 Medicaid churn occurs for two key reasons:

  • Household income fluctuation is common among low-income populations. These include hourly and seasonal workers, young adults, individuals leaving incarceration, and households with young children.4 Among parents working hourly jobs, 70 percent to 80 percent have erratic schedules, causing income fluctuations throughout the year.5 One study found that 74 percent of individuals in the lowest income quintile have a more than 30 percent month-to-month change in total income.6 These income fluctuations may cause low-income individuals to lose and regain Medicaid eligibility several times a year.
  • People face numerous barriers when they attempt to renew Medicaid. Most Medicaid disenrollments occur when individuals — who may still be eligible for Medicaid — lose coverage because they did not receive a renewal notice, did not understand the process, or did not respond within the required time frame (such as 10 days).7 These procedural disenrollments occur frequently, and account for approximately 70 percent of disenrollments since the expiration — or “unwinding” — of the continuous coverage requirement that Congress adopted in response to COVID-19.8

Churn disrupts people’s access to health care and increases the administrative burden on state Medicaid agencies.9 Loss of Medicaid coverage, even if temporary, results in people forgoing necessary preventive services, medications, and continuous care for chronic illnesses.10 Unstable coverage also leads to more hospitalizations and ER visits,11 and creates heightened stress for people as they navigate reenrollment.

The pandemic-era continuous coverage requirement, which applied to all Medicaid enrollees, expired in April 2023. Since then, Congress has required states to provide 12-month continuous eligibility for children in Medicaid and the Children’s Health Insurance Program (CHIP) beginning in 2024.12 However, there currently is no federal requirement or state plan option for continuous eligibility for adults, and no state plan option to expand continuous eligibility for children beyond 12 months.

Instead, the FY 2025 House Energy and Commerce Committee’s budget reconciliation bill includes policies that would increase Medicaid enrollment churn by requiring states to renew eligibility for adults covered under Medicaid expansion every six months instead of annually.13 The bill also would prohibit the Health and Human Services secretary from implementing or enforcing Centers for Medicare and Medicaid Services (CMS) regulations that streamline Medicaid renewals for seniors and people with disabilities.14

In this brief, we review the evidence supporting the benefits of continuous eligibility for enrollees and states. We also identify policy actions that Congress could take to ensure stable coverage for the nation’s low-income and underserved populations.

Key Findings

The Importance of Continuous Medicaid Eligibility

The benefits of continuous eligibility, with Medicaid enrollees maintaining uninterrupted coverage regardless of changes in income or other circumstances throughout the year, are well documented:

Continuous eligibility is associated with less churn and fewer uninsured individuals. The temporary federal continuous coverage requirement during the pandemic significantly reduced churn and prevented more than 300,000 Medicaid enrollees from becoming uninsured each month.15 Researchers estimate that continuous Medicaid eligibility would reduce churn by 30 percent and result in 267,000 fewer uninsured adults monthly.16

Prior to implementation of the children’s federal 12-month continuous eligibility requirement, children in states that provided continuous eligibility were significantly less likely to be uninsured (8% vs. 12%) and to experience gaps in coverage (11% vs. 16%).17 Continuous eligibility for children is estimated to have reduced the number of uninsured children by 34,000 each month.18

Continuous eligibility also would eliminate churn that results from data checks for changes in income between annual renewals.19 States conducting these checks have substantially higher churn rates.20 As of May 2024, 34 states were not planning to resume data checks following expiration of the pandemic-era continuous coverage requirement.21

Continuous eligibility reduces state administrative burden and cost. Disenrolling and reenrolling an individual within one year is estimated to cost between $400 and $600 per individual.22 Adopting 12-month continuous eligibility for adults would reduce state Medicaid administrative costs by approximately $87 million.23 Since adopting continuous eligibility for adults, some states have already realized cost savings due to the substantially fewer staff hours needed to process reenrollments.24

Continuous eligibility also results in net savings. If all states had adopted 12-month continuous eligibility for adults, federal and state spending in 2024 would have increased by $479 million and $158 million, respectively.25 These amounts represent increases of only 0.1 percent in acute care for nonelderly Medicaid enrollees.2+ Households and employers, meanwhile, would each have saved about $1 billion a year in health care spending, and total spending would have declined by $1.8 billion in 2024.27

Continuous eligibility reduces enrollees’ health care costs and administrative burden. Research has found that, when compared to those with disrupted coverage, continuously covered individuals have lower monthly health care costs because of consistent access to medical care and medications that stabilize health conditions and prevent hospitalizations.28 Continuous eligibility also reduces the burden and stress for people who must navigate complex renewal or insurance transition processes, resulting in fewer lost workdays.29

Continuous eligibility is associated with better access to care and improved health outcomes. Enrollees with a full, stable year of Medicaid coverage have significantly less difficulty accessing medical care and medication from their network providers.30 Studies have found that people with 12 months of continuous eligibility are twice as likely to seek preventive care during the postpartum period, and are three times more likely to use mental health and substance use disorder services.31 Consequently, continuous coverage is associated with better health, fewer hospitalizations, and fewer ER visits.32

State Waivers Aren’t Enough to Expand Continuous Eligibility

Currently, Section 1115 waivers are the only way that states can adopt continuous eligibility for adults or expand beyond 12 months of continuous eligibility for children. As of August 2024, three states had waivers authorizing continuous eligibility for all adult Medicaid beneficiaries; seven states had waivers for specific populations, such as parents/caregivers, unhoused populations, formerly incarcerated adults, and former foster care youth33; and 12 states had waivers allowing multiyear (24 months to 48 months) continuous eligibility for children.34 As research and states’ experience to date have established the benefits of continuous eligibility, Congress could consider adopting a federal requirement or state plan option. Eliminating the need for states to rely on waivers could also reduce federal and state administrative burdens.

Assisting Low-Income Adults with Medicaid Renewals or Transitions

After 12 months of continuous eligibility, individuals need either to renew Medicaid coverage or to transition to other coverage, such as marketplace plans, if they are no longer eligible for Medicaid. In both cases, enrollees must overcome numerous, well-documented administrative barriers or they will risk becoming uninsured.35 For example, over 25 million people lost Medicaid during the Medicaid unwinding36; nearly one-quarter (23%) of those disenrolled from Medicaid have become uninsured.37 The benefits of providing support to enrollees are well documented:

Automated renewals prevent churn. According to the Centers for Medicare and Medicaid Services (CMS), increasing the number of automated Medicaid coverage renewals (or “ex parte” renewals) is the most effective method for ensuring coverage continuity and preventing churn.38 Currently, all states must take an ex parte approach to Medicaid renewals, in which they attempt to renew coverage based on available data before requesting information from enrollees. However, the effectiveness of state ex parte approaches varies widely, resulting in automated Medicaid renewal rates that range from 3 percent to 99 percent.39 As of 2023, CMS found 26 states “out of compliance” with ex parte requirements, suggesting the need for more robust approaches to automated renewal.40 When ex parte renewals are successful, they are associated with reduced state costs and processing time, as well as significantly fewer disenrolled individuals.41

States with higher rates of ex parte renewals use more robust approaches, and numerous states submitted waivers to adopt these approaches during the pandemic. Many states have waivers to renew coverage for adults without further verification if no current income information is available from electronic databases. (Thirty-six states automatically renew Medicaid for individuals previously documented to have zero income, and 19 states automatically renew coverage for people previously documented to have income below 100% of the federal poverty level.42) More than half of states have a waiver to renew adult Medicaid coverage based on data from the Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF).43 Seven states use the streamlined Express Lane Eligibility (ELE) option to renew children’s coverage based on household income information from SNAP, TANF, and other programs.44

In-person assistance with Medicaid renewals and marketplace transitions improves continuity of coverage. People receiving in-person assistance are nearly twice as likely to successfully enroll in coverage compared to individuals without help, and targeted outreach prevents procedural disenrollments and reduces churn.45 Currently, at least 30 states provide community-based Medicaid and marketplace navigation programs,46 and 20 states and the District of Columbia allow managed care organizations to support enrollment. States also place eligibility workers in community health centers (CHCs)47; in 2022, nearly 7,500 outreach and enrollment staff in CHCs provided help with approximately 4 million enrollments.48 Studies demonstrate that community-based, in-person assistance with coverage renewals and transitions eliminates barriers related to technology, stress, and confusion with complex applications, especially among communities of color, immigrants, and unhoused populations.49

Additional Action Would Help Fill the Coverage Gap in Nonexpansion States

The Affordable Care Act’s Medicaid expansion is another strategy proven to improve continuity of coverage for low-income people. In expansion states, half a million fewer adults experience churn annually.50 To prevent coverage disruptions, Congress could create a federal “fallback” program to cover low-income individuals who are currently ineligible for both Medicaid and marketplace subsidies because they live in the 10 nonexpansion states.51

Policy Implications

Congress has several options for expanding continuous Medicaid eligibility and ensuring uninterrupted coverage renewals or marketplace transitions after 12 months:

Adopt a new federal requirement for 12-month continuous eligibility for adults. The positive effects of ensuring continuous eligibility for all people with Medicaid are demonstrated by research. Having a unified federal policy of continuous eligibility for all also avoids the administrative burden of applying different policies to different populations.

Alternatively, the federal government could provide states with the option of amending their state plan, which is less administratively burdensome than 1115 waivers and could pave the way for a federal requirement. State plan amendments do not require the same detailed application process, negotiations prior to obtaining federal approval, and ongoing monitoring and evaluation that 1115 waivers do.

Approve a new state plan option for multiyear continuous eligibility for children. Creating a state plan option would eliminate the need for states to use waivers, which can create additional administrative burden.

Adopt new federal requirements or state plan options to increase ex parte coverage renewals. Removing the need for state waivers would enable states to continue successful strategies adopted during the pandemic while reducing administrative burden.

Increase federal funding for in-person assistance with coverage renewals and transitions. The federal government could increase funding to Medicaid, marketplace navigator programs, and community health centers to support individuals with Medicaid renewals and marketplace transitions.

Conclusion

Research shows that Medicaid 12-month continuous eligibility effectively reduces churn, resulting in benefits to enrollees and states. Congress could adopt 12-month continuous eligibility for adults, along with other effective policies to reduce churn. Instead, the House Energy and Commerce Committee’s FY 2025 budget reconciliation bill includes policy changes that research shows would increase Medicaid enrollment churn as well as administrative burden and costs for states and enrollees.

HOW WE CONDUCTED THIS STUDY

We scanned state policy databases maintained by the Centers for Medicare and Medicaid Services (CMS) and KFF to understand state approaches to reducing Medicaid churn. We then reviewed more than 50 articles, including peer-reviewed studies and gray literature, to identify evidence of the effect these approaches have had on Medicaid churn, administrative burden, and cost. We outlined several actions Congress could take to scale the most successful approaches.

NOTES
  1. Alice Burns et al., 10 Things to Know About Medicaid (KFF, Feb. 2025). ↩
  2. Edwin Park, Joan Alker, and Alexandra Corcoran, Jeopardizing a Sound Investment: Why Short-Term Cuts to Medicaid Coverage During Pregnancy and Childhood Could Result in Long-Term Harm (Commonwealth Fund, Dec. 2020). ↩
  3. Medicaid and CHIP Payment and Access Commission, An Updated Look at Rates of Churn and Continuous Coverage in Medicaid and CHIP (MACPAC, Oct. 2021); and Sarah Sugar et al., Medicaid Churning and Continuity of Care: Evidence and Policy Considerations Before and After the COVID-19 Pandemic (U.S. Department of Health and Human Services, Assistant Secretary for Planning and Evaluation, Office of Health Policy, Apr. 2021). ↩
  4. Jennifer Wagner and Judith Solomon, Continuous Eligibility Keeps People Insured and Reduces Costs (Center on Budget and Policy Priorities, May 2021); and Sarah Sugar et al., Medicaid Churning and Continuity of Care: Evidence and Policy Considerations Before and After the COVID-19 Pandemic (U.S. Department of Health and Human Services, Assistant Secretary for Planning and Evaluation, Office of Health Policy, Apr. 2021). ↩
  5. Liz Ben-Ishai, Volatile Job Schedules and Access to Public Benefits (Center for Law and Social Policy, Sept. 2015). ↩
  6. Anthony Hannagan and Jonathan Morduch, Income Gains and Month-to-Month Income Volatility: Household Evidence from the U.S. Financial Diaries (U.S. Financial Diaries, Mar. 16, 2015); and Diana Farrell and Fiona Greig, Paychecks, Paydays, and the Online Platform Economy (JPMorgan Chase & Co. Institute, Feb. 2016). ↩
  7. Jennifer Tolbert, Robin Rudowitz, and Patrick Drake, “Understanding Medicaid Procedural Disenrollment Rates,” KFF, Sept. 7, 2023. ↩
  8. Adrianna McIntyre et al., “Coverage and Access Changes During Medicaid Unwinding,” JAMA Health Forum 5, no. 6 (June 29, 2024): e242193. ↩
  9. Sarah Sugar et al., Medicaid Churning and Continuity of Care: Evidence and Policy Considerations Before and After the COVID-19 Pandemic (U.S. Department of Health and Human Services, Assistant Secretary for Planning and Evaluation, Office of Health Policy, Apr. 2021). ↩
  10. MaryBeth Musumeci, “Taking Action to Reduce Medicaid Churn and Keep People Continuously Enrolled in Coverage,” To the Point (blog), Commonwealth Fund, July 3, 2024. ↩
  11. Ritesh Banerjee, Jeanette Y. Ziegenfuss, and Nilay D. Shah, “Impact of Discontinuity in Health Insurance on Resource Utilization,” BMC Health Services Research 10, no. 195 (2010): 1–10. ↩
  12. Daniel Tsai, “State Health Official Letter (SHO) #25-001 RE: Section 5112 Requirement for All States to Provide Continuous Eligibility to Children in Medicaid and CHIP Under the Consolidated Appropriations Act, 2023,” Centers for Medicare and Medicaid Services, Jan. 15, 2025. ↩
  13. U.S. House of Representatives, Committee Print, Providing for Reconciliation Pursuant to H. Con. Res. 14, the Concurrent Resolution on the Budget for Fiscal Year 2025, Title IV — Energy and Commerce, Subtitle D — Health, Part 1 — Medicaid, Subpart A — Reducing Fraud and Improving Enrollment Processes, Sec. 44102, Moratorium on Implementation of Rule Relating to Eligibility and Enrollment for Medicaid, CHIP, and the Basic Health Program (May 11, 2025), https://d1dth6e84htgma.cloudfront.net/Subtitle_D_Health_ae3638d840.pdf. ↩
  14. U.S. House of Representatives, Committee Print, Providing for Reconciliation Pursuant to H. Con. Res. 14, the Concurrent Resolution on the Budget for Fiscal Year 2025, Title IV — Energy and Commerce, Subtitle D — Health, Part 1 — Medicaid, Subpart A — Reducing Fraud and Improving Enrollment Processes, Sec. 44108, Increasing Frequency of Eligibility Re-Determinations for Certain Individuals (May 11, 2025), https://d1dth6e84htgma.cloudfront.net/Subtitle_D_Health_ae3638d840.pdf. ↩
  15. Daniel B Nelson et al., “Continuous Medicaid Coverage During the COVID-19 Public Health Emergency Reduced Churning, but Did Not Eliminate It,” Health Affairs Scholar 1, no. 5 (Nov. 2023): 1–7. ↩
  16. Medicaid and CHIP Payment and Access Commission, An Updated Look at Rates of Churn and Continuous Coverage in Medicaid and CHIP (MACPAC, Oct. 2021); Matthew Buettgens, Ensuring Continuous Eligibility for Medicaid and CHIP: Coverage and Cost Impacts for Children (Commonwealth Fund, Sept. 2023); and Sarah Sugar et al., Medicaid Churning and Continuity of Care: Evidence and Policy Considerations Before and After the COVID-19 Pandemic (U.S. Department of Health and Human Services, Assistant Secretary for Planning and Evaluation, Office of Health Policy, Apr. 2021). ↩
  17. Erin Brantley and Leighton Ku, “Continuous Eligibility for Medicaid Associated with Improved Child Health Outcomes,” Medical Care Research and Review 79, no. 3 (June 2022): 404–13. ↩
  18. Matthew Buettgens, Ensuring Continuous Eligibility for Medicaid and CHIP: Coverage and Cost Impacts for Children (Commonwealth Fund, Sept. 2023). ↩
  19. Linn Jennings and Rob Nelb, “Updated Analyses of Churn and Coverage Transitions” (presentation, Medicaid and CHIP Payment and Access Commission, Apr. 7, 2022); and Medicaid and CHIP Payment and Access Commission, An Updated Look at Rates of Churn and Continuous Coverage in Medicaid and CHIP (MACPAC, Oct. 2021). ↩
  20. Medicaid and CHIP Payment and Access Commission, An Updated Look at Rates of Churn and Continuous Coverage in Medicaid and CHIP (MACPAC, Oct. 2021); Shefali Luthra, “In Texas, People with Fluctuating Incomes Risk Being Cut Off from Medicaid,” National Public Radio, June 14, 2017; and Samantha Artiga and Olivia Pham, Recent Medicaid/CHIP Enrollment Declines and Barriers to Maintaining Coverage (KFF, Sept. 2019). ↩
  21. Tricia Brooks et al., A Look at Medicaid and CHIP Eligibility, Enrollment, and Renewal Policies During the Unwinding of Continuous Enrollment and Beyond (KFF, June 2024). ↩
  22. Katherine Swartz et al., “Evaluating State Options for Reducing Medicaid Churn,” Health Affairs 34, no. 7 (July 2015): 1180–87. ↩
  23. Matthew Buettgens, Ensuring Continuous Eligibility for Medicaid and CHIP: Coverage and Cost Impacts for Adults (Commonwealth Fund, Sept. 2023). ↩
  24. Niranjana Kowlessar et al., Federal Evaluation of Montana Health and Economic Livelihood Partnership (HELP): Draft Interim Evaluation Report (Social & Scientific Systems, July 22, 2019). ↩
  25. Matthew Buettgens, Ensuring Continuous Eligibility for Medicaid and CHIP: Coverage and Cost Impacts for Adults (Commonwealth Fund, Sept. 2023). ↩
  26. Matthew Buettgens, Ensuring Continuous Eligibility for Medicaid and CHIP: Coverage and Cost Impacts for Adults (Commonwealth Fund, Sept. 2023). ↩
  27. Matthew Buettgens, Ensuring Continuous Eligibility for Medicaid and CHIP: Coverage and Cost Impacts for Adults (Commonwealth Fund, Sept. 2023). ↩
  28. Tricia Brooks and Allexa Gardner, Continuous Coverage in Medicaid and CHIP (Georgetown University Center for Children and Families, July 2021); and Leighton Ku, Erika Steinmetz, and Tyler Bysshe, Continuity of Medicaid Coverage in an Era of Transition (Working Paper, Association for Community Affiliated Plans, Nov. 2015). ↩
  29. “Multi-Year Continuous Eligibility for Children,” Georgetown Center for Children and Families, accessed Dec. 10, 2024. ↩
  30. Government Accountability Office, States Made Multiple Program Changes, and Beneficiaries Generally Reported Access Comparable to Private Insurance (GAO, Nov. 2012); and Cara Orfield et al., “The Affordable Care Act and Access to Care for People Changing Coverage Sources,” American Journal of Public Health 105, no. 5 (Nov. 2015): S651–S657. ↩
  31. Xiao Wang et al., “Extending Postpartum Medicaid Beyond 60 Days Improves Care Access and Uncovers Unmet Needs in a Texas Medicaid Health Maintenance Organization,” Frontiers in Public Health 10, no. 841832 (May 2, 2022). ↩
  32. Erin Brantley and Leighton Ku, “Continuous Eligibility for Medicaid Associated with Improved Child Health Outcomes,” Medical Care Research and Review 79, no. 3 (June 2022): 404–13; Georgetown University Center for Children and Families, Medicaid and CHIP Continuous Coverage for Children (Georgetown University Center for Children and Families, Oct. 2022); Edwin Park, Joan Alker, and Alexandra Corcoran, Jeopardizing a Sound Investment: Why Short-Term Cuts to Medicaid Coverage During Pregnancy and Childhood Could Result in Long-Term Harm (Commonwealth Fund, Dec. 2020); and Government Accountability Office, States Made Multiple Program Changes, and Beneficiaries Generally Reported Access Comparable to Private Insurance (GAO, Nov. 2012). ↩
  33. “Medicaid Waiver Tracker: Approved and Pending Section 1115 Waivers by State,” KFF, Dec. 5, 2024; and Tricia Brooks et al., A Look at Medicaid and CHIP Eligibility, Enrollment, and Renewal Policies During the Unwinding of Continuous Enrollment and Beyond (KFF, June 2024). ↩
  34. Caroline Hogan et al., New Federal 12-Month Continuous Eligibility Expansion: Over 17 Million Children Could Gain New Protections from Coverage Disruptions (U.S. Department of Health and Human Services, Assistant Secretary for Planning and Evaluation, Office of Health Policy, Mar. 2024); and Cindy Mann and Emma Daugherty, “States Are Adopting New Policies to Help Children Stay Enrolled in Medicaid and CHIP,” To the Point (blog), Commonwealth Fund, Dec. 20, 2023. ↩
  35. Jennifer Tolbert, Robin Rudowitz, and Patrick Drake, “Understanding Medicaid Procedural Disenrollment Rates,” KFF, Sept. 7, 2023; Natasha Murphy and Sarah Millender, How States Can Build Bridges by Smoothing Medicaid-to-Marketplace Coverage Transitions (Center for American Progress, Feb. 2023); and “Nearly a Quarter of People Who Say They Were Disenrolled from Medicaid During the Unwinding Are Now Uninsured,” news release, KFF, Apr. 12, 2024. ↩
  36. “Medicaid Enrollment and Unwinding Tracker,” KFF, Jan. 31, 2025. ↩
  37. Lunna Lopes, et al., “KFF Survey of Medicaid Unwinding,” KFF, Apr. 12, 2024. ↩
  38. “Medicaid, CHIP, and Marketplace Enrollments: Enrollment Trends Update” (presentation, Centers for Medicare and Medicaid Services, Dec. 18, 2023). ↩
  39. Bradley Corallo and Jennifer Tolbert, “Understanding Medicaid Ex Parte Renewals During the Unwinding,” KFF, Oct. 2, 2023. ↩
  40. Bradley Corallo and Jennifer Tolbert, “Understanding Medicaid Ex Parte Renewals During the Unwinding,” KFF, Oct. 2, 2023. ↩
  41. “Medicaid and CHIP Enrollment: Child and Youth Data Snapshot” (presentation, Centers for Medicare and Medicaid Services, Dec. 18, 2023); Laura Summer and Cindy Mann, Instability of Public Health Insurance Coverage for Children and Their Families: Causes, Consequences, and Remedies (Georgetown University Health Policy Institute and Commonwealth Fund, June 2006); and Tackling the Time Tax — 2024 Edition: Making Important Government Benefits and Programs Easier to Access (Executive Office of the President of the United States, Office of Information and Regulatory Affairs, July 2024). ↩
  42. “COVID-19 PHE Unwinding Section 1902(e)(14)(A) Waiver Approvals,” Medicaid.gov, updated Dec. 11, 2024. ↩
  43. “COVID-19 PHE Unwinding Section 1902(e)(14)(A) Waiver Approvals,” Medicaid.gov, updated Dec. 11, 2024. ↩
  44. “Express Lane Eligibility for Medicaid and CHIP Coverage,” Medicaid.gov, Aug. 6, 2021; and “COVID-19 PHE Unwinding Section 1902(e)(14)(A) Waiver Approvals,” Medicaid.gov, updated Dec. 11, 2024. ↩
  45. Zachary Baron, In-Person Assistance Maximizes Enrollment Success (Enroll America, Mar. 2014); Tackling the Time Tax — 2024 Edition: Making Important Government Benefits and Programs Easier to Access (Executive Office of the President of the United States, Office of Information and Regulatory Affairs, July 2024); “Available State Strategies to Minimize Terminations for Procedural Reasons During the COVID-19 Unwinding Period: Operational Considerations for Implementation” (presentation, Center for Medicaid and CHIP Services, Dec. 2023); and Jennifer Edwards and Diana Rodin, Profiles of Medicaid Outreach and Enrollment Strategies: Helping Families Maintain Coverage in Michigan (Kaiser Commission on Medicaid and the Uninsured, May 2013). ↩
  46. Tricia Brooks, Natalie Lawson, and Hannah Green, State Medicaid and CHIP Outreach Resources and Enrollment Assistance Snapshot (Georgetown Center for Children and Families, May 2024); and “2024–2025 CMS Navigator Cooperative Agreement Awardees,” Centers for Medicaid and Medicare Services, accessed Dec. 10, 2024. ↩
  47. “§ 435.904 Establishment of Outstation Locations to Process Applications for Certain Low-Income Eligibility Groups,” Code of Federal Regulations, title 42 (2024): 435.904. ↩
  48. “Health Centers Help People Get — and Stay — Covered,” NACHC Blog, National Association of Community Health Centers, Dec. 12, 2023. ↩
  49. Cara Karter, SNAP Application Assistance in Illinois During COVID-19: Outreach Workers’ Perspectives (mRelief, July 2021); Suzanne Wikle et al., States Can Reduce Medicaid’s Administrative Burdens to Advance Health and Racial Equity (Center on Budget and Policy Priorities, July 2022); and Natasha Murphy and Sarah Millender, How States Can Build Bridges by Smoothing Medicaid-to-Marketplace Coverage Transitions (Center for American Progress, Feb. 2023). ↩
  50. Anna L. Goldman and Benjamin D. Sommers, “Among Low-Income Adults Enrolled in Medicaid, Churning Decreased After the Affordable Care Act,” Health Affairs 39, no. 1 (Jan. 2020): 85–93; and Leighton Ku and Isabel Platt, “Duration and Continuity of Medicaid Enrollment Before the COVID-19 Pandemic,” JAMA Health Forum 3, no. 12 (Dec. 16, 2022): e224732. ↩
  51. Sara R. Collins and Avni Gupta, The State of Health Insurance Coverage in the U.S.: Findings from the Commonwealth Fund 2024 Biennial Health Insurance Survey (Commonwealth Fund, Nov. 2024). ↩

Publication Details

Date

Contact

MaryBeth Musumeci, Associate Teaching Professor, Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University

Citation

MaryBeth Musumeci et al., Reducing Medicaid Churn: Policies to Promote Stable Health Coverage and Access to Care (Commonwealth Fund, June 2025). https://doi.org/10.26099/k808-3424

Area of Focus

Topics

Medicaid,
Churning,
Medicaid Waivers,
Medicaid Expansion,
Continuous Coverage Requirement,
Administrative Costs,
Income Based Disparities,
Children's Health Insurance Program,
Government Programs & Policies,
State Health Policy and Medicaid,
Coverage and Access

Related Content