It’s been a weird few years for healthcare in America. Honestly, if you haven't checked your mail lately, you might be in for a rude awakening. For a long time, the rules didn't change because they couldn't. During the COVID-19 public health emergency, the federal government basically told states they couldn't kick anyone off Medicaid. It was a "continuous enrollment" provision. It kept people covered regardless of whether their income spiked or they moved houses. But that safety net is gone. Now, we are in the middle of what policy experts call "the unwinding."
Millions are out.
According to data tracked by KFF (formerly the Kaiser Family Foundation), over 25 million people have been disenrollment since the unwinding began in early 2023. That is a staggering number. It’s not just a statistic; it’s parents, kids, and seniors who suddenly find themselves at a pharmacy counter being told their insurance is inactive. Understanding who will be losing Medicaid isn't just about income brackets anymore. It’s about paperwork, administrative errors, and a process that is, quite frankly, a bit of a mess in several states.
The Paperwork Trap: Why Eligible People Are Getting Cut
You’d think you only lose Medicaid if you start making too much money. That’s the logical assumption. But the reality is much more frustrating. A huge chunk of the people losing coverage are actually still eligible.
This is what’s known as a "procedural disenrollment."
Basically, the state sends a renewal packet to an old address. Or the recipient doesn't understand the 20-page document. Maybe they forgot to sign page 14. In states like Texas and Florida, procedural red tape has been a primary driver of coverage loss. In fact, early on in the unwinding process, some states saw procedural termination rates as high as 70% or 80%. That’s wild. It means the state didn't actually determine the person was "too rich" for Medicaid; they just stopped hearing from them and hit the "off" switch.
The Impact on Children
Kids are getting hit the hardest. It’s heartbreaking. Even though the income threshold for the Children’s Health Insurance Program (CHIP) is much higher than it is for adults, children are being swept up in these mass cancellations. When a parent loses coverage due to paperwork issues, the kids often lose it too, even if their eligibility hasn't changed at all.
Joan Alker, executive director of the Georgetown University Center for Children and Families, has been ringing the alarm on this for over a year. She’s noted that in states that didn't expand Medicaid, the risk to children is even more pronounced. We are seeing a massive reversal in the progress made over the last decade in reducing the number of uninsured children in the U.S.
Income Volatility and the "Churn"
Then there’s the group of people who actually did have a change in circumstances. If you got a raise or a new job that pays $18 an hour instead of $15, you might suddenly find yourself in the "coverage gap." This is especially true in the 10 states that still haven't expanded Medicaid under the Affordable Care Act.
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In these states—places like Alabama, Georgia, and South Carolina—the income limits for adults are incredibly low. Sometimes, earning more than $300 a month is enough to disqualify a single parent.
The "churn" is a real problem. People’s lives are messy. You might work a seasonal job that puts you over the limit for three months, only to have your hours cut later. Re-enrolling isn't like flipping a light switch. It takes time, effort, and a lot of phone calls to automated systems that put you on hold for two hours.
Who Will Be Losing Medicaid Next?
The process isn't over. While some states moved fast, others are still working through their backlogs. If you haven't been contacted yet, don't assume you're safe.
- Young adults who aged out of foster care or reached the age of 19-21 (depending on the state) are frequently targeted for review.
- Postpartum mothers who were covered under pregnancy-related Medicaid are seeing their coverage expire, though many states have thankfully extended this to 12 months.
- Seniors on "Dual Eligibility" who receive both Medicare and Medicaid are at risk if their assets—like a small life insurance policy or a modest savings account—slightly exceed the limits.
Specific groups are more vulnerable because of how the system is built. For example, people with limited English proficiency often struggle with the dense legal jargon in renewal notices. If the state doesn't provide a clear, translated version of the "Respond by this date" warning, that person is almost guaranteed to lose coverage.
Regional Differences are Massive
Where you live matters more than almost anything else. If you live in a state like Oregon or Washington, the state government has been proactive. They use "ex parte" renewals, which means they check other databases (like SNAP or wage records) to automatically renew people without making them fill out forms.
Down south? Not so much.
States with more aggressive "purging" mentalities have been faster to cut people off and slower to provide help. If you’re in a state that didn't expand Medicaid, the "who" in who will be losing Medicaid is basically any adult who isn't pregnant, disabled, or extremely low-income.
The Hidden Costs of Losing Coverage
When people lose Medicaid, they don't just stop needing doctors. They just stop going to them.
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This leads to a spike in Emergency Room visits for things that could have been handled with a $20 prescription. It puts a massive strain on "safety net" hospitals. When a hospital treats thousands of uninsured patients, their budget craters. We’ve already seen rural hospitals closing at an alarming rate over the last five years. The unwinding is only accelerating that trend.
Think about the guy with Type 1 diabetes. If he loses his Medicaid because of a mailing address error, he might skip his insulin for a few days. That leads to ketoacidosis. That leads to an ICU stay that costs $50,000. Guess who pays for that eventually? We all do, through higher insurance premiums and tax-funded hospital subsidies. It is a classic case of being "penny wise and pound foolish."
Misconceptions About the Marketplace
A common talking point is that people losing Medicaid can "just go to the Marketplace" (Healthcare.gov).
Sure, some can. But it’s not that simple.
For someone living at 110% of the federal poverty level, even a "silver" plan with a $0 premium might have a $5,000 deductible. If you're living paycheck to paycheck, a $5,000 deductible is basically the same as having no insurance at all. You aren't going to the doctor unless your arm is hanging off.
Furthermore, the transition isn't automatic. You have a limited window—a Special Enrollment Period—to sign up for a Marketplace plan once your Medicaid ends. If you miss that window because you didn't realize your Medicaid was cancelled until you went to the pharmacy three months later, you’re stuck. Totally uninsured.
Why Some People are "Voluntarily" Leaving
Believe it or not, some people are just giving up. The administrative burden—the "time tax"—is real. If you have to spend ten hours on the phone and scan thirty pages of documents just to keep insurance that many doctors in your area don't even accept, you might just decide it’s not worth it.
This is especially true for the "working poor" who have two jobs and zero free time during business hours when the Medicaid offices are actually open.
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Actionable Steps If You Are at Risk
If you’re worried about who will be losing Medicaid, or if you think you might be on the chopping block, you need to be proactive. Waiting for the state to do the right thing is a gamble you’ll probably lose.
Update Your Contact Info Immediately
Log into your state’s Medicaid portal right now. Check your mailing address, your phone number, and your email. If they can’t find you, they will cut you. It’s that simple.
Check Your Mail Like a Hawk
Look for envelopes that look official. Some states use nondescript white envelopes that look like junk mail. Do not throw anything away without reading it. If you see a "Renewal" or "Redetermination" notice, prioritize it over everything else.
Gather Your Documents Now
You’re going to need pay stubs, tax returns, and proof of residency. Having these in a folder (digital or physical) will save you a massive headache when the deadline hits.
Understand Your Alternatives
If you truly are over the income limit, don't panic.
- Employer Coverage: Check if your job offers a plan. Losing Medicaid is a "qualifying life event," so you can sign up even if it's not open enrollment.
- Healthcare.gov: Look for plans with "Cost Sharing Reductions" (CSRs). These are only available on Silver-level plans and can drastically lower your out-of-pocket costs if your income is low.
- Community Health Centers: These clinics offer sliding-scale fees based on your income. They are a literal lifesaver if you end up in the coverage gap.
Appeal if You Disagree
If you get a denial notice and you think the state got your income wrong, appeal it. You usually have a specific window (often 30 to 90 days) to request a fair hearing. In many cases, you can keep your coverage while the appeal is pending.
The unwinding is a massive logistical challenge, and the system is prone to breaking. You have to be your own advocate. The numbers show that millions are falling through the cracks, but a little bit of preparation can keep you from being one of them. Keep your documents ready, stay on top of the mail, and don't take "no" for an answer if you know you're still eligible. It's a frustrating process, but your health is worth the bureaucratic battle.