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Federal policy kept millions on Medicaid rolls during pandemic—but many didn’t realize they still had coverage

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Staff Writer

April 8, 2024

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April 8, 2024—Far more people were enrolled in Medicaid during the pandemic than who reported in surveys having coverage—a discrepancy suggesting that many people were unaware that their coverage had continued under federal policies, according to a new study by Harvard T.H. Chan School of Public Health.

The finding has implications for the current process of “Medicaid unwinding,” under which states are removing people from the Medicaid rolls now that federal policies have changed.

The study was published April 5 in JAMA Health Forum. Its authors were Adrianna McIntyre, assistant professor of health policy and politics; Rebecca Smith, graduate research assistant; and Ben Sommers, the Huntley Quelch Professor of Health Care Economics, all in the Department of Health Policy and Management. The research was supported by a grant from the Commonwealth Fund.

Enrollment in Medicaid—the program that provides health insurance to low-income Americans—rose to historic levels during the pandemic. That’s because federal “continuous coverage” policies prevented states from dropping people from Medicaid, to help keep people insured. But those policies expired in 2023, and states began the “unwinding” process—checking people’s eligibility, which normally happens annually, and disenrolling them if they were no longer eligible. As of April 2024, more than 19 million people had been removed from the program.

The new study looked at how self-reported Medicaid coverage compared to actual Medicaid enrollment. Self-reported data came from the American Community Survey (ACS), which asked more than 12.5 million Americans about their insurance coverage between 2019 and 2022. Actual enrollment data came from the Centers for Medicare & Medicaid Services (CMS).

The study found that self-reported Medicaid coverage was significantly lower than actual Medicaid enrollment. According to ACS data, Medicaid coverage increased 1.3% from 2019 to 2022—lower than the 5.2% increase the CMS saw.

“The implication is that millions of people probably didn’t understand that their Medicaid had continued, and that the 19 million people who’ve been dropped during the ongoing unwinding process may reflect many people who already thought they had left or lost Medicaid,” McIntyre said. “Our findings also tell us that future efforts to make coverage more stable in Medicaid through continuous eligibility policies won’t work if people don’t understand how those policies affect their enrollment.”

Read the study: Survey-Reported Coverage in 2019-2022 and Implications for Unwinding Medicaid Continuous Eligibility

Learn more

The problem with Medicaid ‘unwinding’ (Harvard Chan School news)

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