The Scale of Medicaid Coverage Loss
Medicaid is at a critical crossroads. Millions of Americans face losing their health coverage — and new reports confirm this will happen even under the most optimistic projections. The scale of the crisis demands urgent attention from policymakers, healthcare providers, and the public alike.
A recent KFF analysis estimates that between 8 million and 24 million people could lose Medicaid coverage during the unwinding of the pandemic-era continuous enrollment provision. Even at the midpoint — an 18% decline across all states — roughly 17 million people stand to lose their coverage. These are not abstract numbers. These are families, children, elderly adults, and people with disabilities who depend on Medicaid to survive.
Moreover, the Congressional Budget Office (CBO) projects that the One Big Beautiful Bill Act alone could reduce Medicaid enrollment and leave millions uninsured by 2034. The CBO estimates that 7.8 million people would become uninsured due to its Medicaid provisions.
Why Even the Best Scenario Falls Short
Pandemic-Era Protections Are Now Gone
During the COVID-19 pandemic, Congress enacted the Families First Coronavirus Response Act. This law required states to keep people continuously enrolled in Medicaid in exchange for enhanced federal funding. As a result, enrollment surged by an estimated 20 million people between February 2020 and March 2023.
However, Congress ended the continuous enrollment provision in December 2022. States began resuming disenrollments on April 1, 2023. Since then, coverage losses have grown rapidly — even among people who remain fully eligible.
Administrative Barriers Are Driving People Off the Rolls
Many enrollees are losing coverage not because they are ineligible, but because they cannot navigate complex renewal paperwork. Additionally, states have made procedural errors — sending incorrect notices, failing to auto-renew eligible members, and terminating coverage inappropriately. Furthermore, nearly a quarter of adults who were disenrolled subsequently became uninsured, according to a KFF survey.
Therefore, the best-case scenario still leaves millions vulnerable. The system itself is creating barriers to coverage that eligible people simply cannot overcome.
Who Is Most at Risk?
Children and Low-Income Adults
Children represent a significant portion of potential coverage losses. KFF projects that between 2 million and 7 million children could lose Medicaid. At the same time, adults with low incomes — especially those enrolled under ACA Medicaid expansion — face heightened risk.
People With Disabilities and Chronic Conditions
People with disabilities are especially vulnerable. Many have not yet secured a formal disability determination. As a result, they remain enrolled through income-based pathways that could be cut. Consequently, even exemptions for disability groups will not protect everyone.
Rural Communities
Rural residents face a unique threat. Many depend on community health centers and local hospitals that are already financially fragile. As Medicaid enrollment drops, these facilities lose revenue. Some may close entirely — leaving entire communities without access to care.
Work Requirements Are Making Things Worse
A Flawed Policy With High Human Costs
New Medicaid work requirements included in recent federal legislation target working-age adults. However, researchers from the Urban Institute found that one in three adults enrolled in Medicaid expansion who already work or attend school are still at risk of losing coverage. This is because irregular hours, seasonal layoffs, and complex reporting requirements make compliance difficult.
The CBO estimates that work requirements alone will cause 4.8 million people to lose Medicaid. Critically, the vast majority of those people are already working or have legitimate exemptions. The problem is not eligibility — it is paperwork.
A Lesson From Arkansas
Arkansas previously piloted a Medicaid work requirement program. The results were clear. Thousands lost coverage not because they stopped working, but because they missed a reporting deadline. States later had to reverse many of those terminations. This precedent shows the real-world impact of bureaucratic compliance requirements on vulnerable populations.
The Ripple Effect on Health Systems
Providers and Health Centers Under Pressure
When patients lose Medicaid, health systems feel the impact immediately. Community health centers (CHCs) could lose up to $32 billion in revenue if work requirements take full effect, according to a Commonwealth Fund analysis. These centers serve over 31 million people annually — many of whom have no other option for primary care.
Similarly, rural hospitals that were already operating at the edge of solvency face potential closure. Therefore, Medicaid cuts do not just affect enrollees — they threaten the entire infrastructure of care for low-income communities.
Medicare Beneficiaries Are Also at Risk
Medicaid also supports over 7 million older adults who rely on both Medicare and Medicaid. Additionally, many paid caregivers for Medicare beneficiaries qualify for Medicaid due to low wages. If those caregivers lose coverage and their health deteriorates, the people they care for face serious consequences as well.
What Needs to Happen Now
Protecting Eligible Enrollees
States must take proactive steps to keep eligible people enrolled. This includes investing in ex parte renewal processes — automatic renewals using existing data — and reducing reliance on paper notices. Moreover, federal agencies must hold states accountable for high procedural disenrollment rates.
Reversing Harmful Policy Changes
Congress must reconsider work requirements and other administrative barriers that predictably push eligible people off Medicaid. Evidence consistently shows these policies increase the uninsured rate without meaningfully increasing workforce participation.
Expanding Outreach
Medicaid agencies should partner with community health centers, managed care organizations, and local nonprofits to conduct outreach. Many enrollees do not realize their coverage is at risk. Early intervention can prevent unnecessary disenrollments.
