Over the past couple of years, a massive shift has taken place in how Americans get their health coverage. During the COVID-19 public health emergency, federal rules prevented states from removing people from Medicaid, even if their circumstances changed. Once those protections ended, states began the process known as "unwinding," reviewing eligibility for every Medicaid enrollee and disenrolling those who no longer qualified or who could not be reached for renewal.
The result was significant. Millions of people across the country lost Medicaid coverage, often through no fault of their own. Many were removed simply because their state could not verify their address or income in time. Tracking data from states shows that disenrollment numbers varied widely, with some states moving faster and more aggressively than others.
Who Was Most Affected by Medicaid Disenrollments
The people most likely to lose Medicaid coverage during unwinding fell into a few common groups:
- Adults whose income increased slightly above the Medicaid limit, often due to a raise or a new job
- People who moved and did not update their address with their state Medicaid agency
- Families who never received renewal paperwork because it was sent to an outdated address
- Children who aged out of certain coverage categories
In many cases, people did not realize they had lost coverage until they tried to use it at a pharmacy or doctor's office. This created gaps in care and left many households scrambling to find a new option quickly.
How the ACA Marketplace Fills the Gap
For many people who lost Medicaid, the ACA marketplace became the next logical step. Federal rules give individuals a special enrollment period when they lose Medicaid coverage, meaning they do not have to wait until open enrollment to sign up for a marketplace plan.
Here is how that process generally works:
- You receive a notice that your Medicaid coverage is ending or has ended.
- You have 60 days from the loss of coverage to enroll in a marketplace plan.
- You apply through HealthCare.gov or your state marketplace and report your income.
- Based on your income, you may qualify for premium tax credits that lower your monthly cost significantly.
It is worth knowing that many people who transition from Medicaid find that marketplace plans are more affordable than expected. Premium subsidies under the Affordable Care Act are calculated based on income, and for those near the lower end of the income scale, monthly premiums can be very low or even close to zero after credits are applied.
What to Do If You or Someone You Know Lost Medicaid
If you were recently disenrolled from Medicaid, do not assume you simply have no options. There are steps you can take right away:
- Check whether you qualify for a marketplace plan using the special enrollment period for loss of coverage.
- Gather documents that show your current household income, including recent pay stubs or a tax return.
- Compare plans carefully, looking at both the monthly premium and the out-of-pocket costs like deductibles and copays.
- Contact a licensed broker or navigator who can help you understand your options at no cost to you.
Some people who were removed from Medicaid may actually still qualify and can appeal their state's decision or reapply. If your situation has not changed since you were enrolled, it is worth checking before assuming marketplace coverage is your only path.
Practical takeaway: Losing Medicaid is not the end of the road. A special enrollment window gives you time to find marketplace coverage, and subsidies may make that coverage more affordable than you expect. Act quickly, because the 60-day window moves fast.