Medicaid enrollment changes after COVID-19 and the role of state policies in coverage losses during the unwinding

Tue, 14 Apr 2026 20:08:00 +0200

During the COVID-19 pandemic, Medicaid enrollment in the United States increased significantly due to emergency policies that temporarily halted routine disenrollments. The Families First Coronavirus Response Act required states to maintain continuous coverage for most beneficiaries in exchange for federal funding, while economic disruptions also increased eligibility. As a result, enrollment grew from about 71 million people before the pandemic to a peak of approximately 94.1 million by early 2023.

This trend reversed when the continuous coverage requirement ended in 2022, and states began resuming eligibility checks in April 2023. This process, known as the “Great Unwinding,” led to the disenrollment of more than 25 million people by mid-2025. At the same time, around 56 million individuals had their coverage renewed. A key finding from the unwinding period is that most coverage losses were not due to ineligibility. Instead, about 69% of disenrollments were classified as procedural,