The Great Unwinding

More than a dozen people waited outside a Montana state public assistance office recently before it opened to ensure they were not cut off from Medicaid. People in Missouri and Florida reported spending more than two hours on hold when attempting to renew their Medicaid coverage.

A disabled man in Tennessee who had been on Medicaid for three decades. His parents challenged the state this summer to keep him enrolled as he died in a hospital from pneumonia.

Over 28 million people had their eligibility examined. Over 10 million had their coverage discontinued. Millions more are set to lose Medicaid coverage in the coming months.

The significant reduction in enrollment occurs after federal safeguards that banned states from removing people from Medicaid during the pandemic expired in April. Since March 2020, participation in Medicaid and the linked Children’s Health Insurance Program has increased by more than 22 million to 94 million people.

For many Medicaid beneficiaries , the process of assessing all users’ eligibility has been anything but straightforward. Some people are losing coverage without knowing why. Some are struggling to show that they are still eligible. Medicaid beneficiaries and patient advocates say that their state mailed mandatory renewal applications to out-of-date addresses, didn’t translate documents correctly, and miscalculated income.

According to a survey conducted in February by the Urban Institute, most Americans enrolled in Medicaid are unaware that they must act to maintain their coverage.

Samuel Camacho is a health insurance navigator for the Universal Health Care Action Network of Ohio. Camacho assists Spanish speakers in the Columbus, Ohio, area.

He says the process has become much more difficult because the agency’s local offices in charge of Medicaid have been closed to the public since the start of the pandemic. Because of the closures, people don’t always have access to an interpreter.

Similarly, Jared Nordlund, the Florida director for UnidosUS says that Florida often does a poor job translating Medicaid applications into Spanish. However, the press secretary for Florida’s Department of Children and Families, which manages the state’s Medicaid redetermination process, Miguel Nevarez, called complaints about poor translations and excessive wait times for the Spanish-language phone line a “false narrative.”

Florida has unenrolled approximately 73,000 people from Medicaid since April. People have also waited for 2.5 hours on hold for a representative who speaks Spanish.

Trish Chastain, 35, of Springfield, Missouri, said her Medicaid coverage will stop at the end of the year. Her children are still eligible but she no longer qualifies since her income is too high at $22 per hour. Chastain’s employer, a rehab center, provides health insurance, but her share of the monthly premium is $260.

Doctors and community health center representatives around the country reported an increase in cancellations and no-shows among uninsured patients, including children. States have already disenrolled at least 1.8 million children nationwide in the 20 states that give statistics by age.

Medicaid is a lifeline for millions of Americans. People may remain uninsured if they lose their coverage. Those without insurance cannot receive immediate medical services. They cannot afford medications, doctor visits, preventative care, and other essential services. For some, losing insurance is the difference between life and death.


Galewitz, Phil, et al. “‘Worse than People Can Imagine’: Medicaid ‘unwinding’ Breeds Chaos in States.” KFF Health News, KFF, 3 Nov. 2023, Goldstein, Amy. “Millions Poised to Lose Medicaid as Pandemic Coverage Protections End.” The Washington Post, WP Company, 1 Apr. 2023,

Galewitz, Phil. “As Pandemic-Era Medicaid Provisions Lapse, Millions Approach a Coverage Cliff.” Kaiser Health News, Kaiser Family Foundation, 2 Feb. 2023,

Godoy, Maria. “Medicaid Renewals Are Starting. Those Who Don’t Reenroll Could Get Kicked Off.” NPR, NPR, 21 Mar. 2023,

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