Health Characteristics of Adults Unable to Complete Medicaid Renewal During the Unwinding Period.

Abstract

Importance: Medicaid redetermination affects millions of people annually in the US, but little is known about beneficiaries who lose coverage during the process. In early 2023, after the COVID-19 pandemic mandate to provide continuous coverage was lifted, states resumed redetermination of eligibility and disenrollment of individuals who were no longer eligible. Medicaid disenrollment rose rapidly during this unwinding period, yet little is known about the health and financial characteristics of individuals who were unable to complete the Medicaid renewal process.

Objective: To assess levels of self-reported mental health, functional health, and financial security among current and former Medicaid enrollees during the Medicaid unwinding period.

Design, setting, and participants: This repeated cross-sectional study used nationally representative survey data from multiple waves of the US Census Bureau Household Pulse Survey to assess the health and financial characteristics of 131 384 current and former working-age (19-64 years) Medicaid enrollees interviewed between January 2023 and September 2024. Estimated linear regression models were used to compare measures among current Medicaid enrollees, former enrollees who could not complete renewal (procedural disenrollees), and former enrollees who dropped Medicaid for other reasons (nonprocedural disenrollees). Analysis was performed in December 2024.

Exposure: Medicaid enrollment status and likely reason for disenrolling (procedural vs nonprocedural).

Results: The total sample comprised 131 384 current and former working-age Medicaid enrollees (mean [SD] age, 41.9 [12.5] years; 82 378 females [62.7%]; 22 467 Black [17.1%], 32 715 Hispanic/Latino [24.9%], 62 276 White [47.4%], and 13 927 individuals of other races or multiracial [10.6%]), more than half of whom were parents and of lower socioeconomic status. Compared with current Medicaid enrollees, procedural disenrollees were 3.3 percentage points (pp) more likely to report anxiety (95% CI, 1.6 to 4.9 pp); frequent worrying, 3.3 (95% CI, 1.8 to 4.8) pp; little interest in things, 2.4 (95% CI, 1.0 to 3.8) pp; depression, 2.5 (95% CI, 1.1 to 3.9) pp; food insecurity, 3.6 (95% CI, 2.6 to 4.7) pp; difficulty seeing, 2.0 (95% CI, 1.0 to 3.0) pp; difficulty hearing, 1.1 (95% CI, 0.4 to 1.8) pp; and difficulty remembering things, 1.4 (95% CI, 0.1 to 2.7) pp; however, they were 1.3 pp less likely to report difficulty with mobility (95% CI, -2.5 to -0.2 pp). There was no statistically significant difference between groups in difficulty with bathing and dressing or difficulty understanding things.

Conclusions and relevance: This cross-sectional study found that adults who could not complete the Medicaid renewal process and were procedurally disenrolled during the unwinding period had higher mental health needs, worse functional health, and lower financial security than current enrollees and nonprocedural disenrollees. These findings raise concerns regarding the potential consequences of administrative barriers and Medicaid coverage disruptions on vulnerable populations.