Eligible but Dropped: Procedural Disenrollment During the Medicaid Unwinding, the Children It Reached and the Policies That Could Stop It Happening Again
[Student Name]
University of Phoenix
HCS/455: Health Care Policy: The Past and the Future
Week 4 Assignment
[Instructor Name]
[Date]
The family described in the introduction is a composite written for a model paper.
A composite mother of two in a southern state moved across town in 2022. In the summer of 2023, her children's Medicaid coverage ended. She learned of it at a pharmacy counter when her son's asthma inhaler was not covered. The state had mailed a renewal packet to her old address; when it came back undeliverable, the children were disenrolled. Her income had not changed, and the children were still eligible. They had not lost eligibility; they had lost track of a piece of mail. This paper examines how that happened to millions of people and what policy can do about it.
How the Problem Arose
In March 2020, the Families First Coronavirus Response Act offered states a temporary increase in federal Medicaid matching funds if they kept enrollees continuously covered during the public health emergency. Every state accepted. Medicaid and CHIP enrollment grew from about 71 million to more than 90 million people, as people who would normally have lost coverage at renewal stayed enrolled and new enrollees joined.
The Consolidated Appropriations Act, 2023 ended the continuous enrollment requirement on March 31, 2023, and phased down the extra funding. States then had to redetermine eligibility for every enrollee, a workload far larger than normal, over roughly a year.
What Happened
By the end of the unwinding, more than 25 million people had been disenrolled. About seven in ten were disenrolled for procedural reasons, such as not returning forms, rather than because the state found them ineligible. Some of those people were no longer eligible and would have been disenrolled anyway; many were still eligible, and some re-enrolled within weeks or months, after gaps in coverage.
Rates varied widely by state, depending on how states conducted renewals. States that renewed more people automatically using data they already had, called ex parte renewal, and those that invested in updating addresses and contacting enrollees, had lower procedural disenrollment.
Why Children Were Affected
Children are more likely than their parents to be eligible for Medicaid or CHIP, because eligibility limits for children are higher. Children who lost coverage were therefore especially likely to have been disenrolled despite remaining eligible. Eliason et al. (2025) found that children's coverage losses during the unwinding varied with state policy, including whether states provided continuous eligibility for children and how they structured their CHIP programs.
Low awareness also played a part. Ding et al. (2024) found that millions of people enrolled in Medicaid during the pandemic reported in surveys that they were uninsured. People who do not know they have Medicaid are unlikely to watch for a renewal notice.
Consequences
Gaps in coverage interrupt care. Children miss well-child visits and vaccines, and people with chronic conditions like the son's asthma go without medicines, sometimes ending up in the emergency department. Providers, especially community health centers and children's hospitals, see more uninsured patients and more uncompensated care. And re-enrolling people who should never have lost coverage costs states administrative time.
Policy Responses
Several policies reduce procedural losses. Continuous eligibility for children keeps them covered for a set period regardless of changes. The Consolidated Appropriations Act, 2023 required 12 months of continuous eligibility for children in Medicaid and CHIP beginning in January 2024, and some states have sought federal approval to extend continuous coverage for young children through age five or six. Ex parte renewal, using income and other data states already hold, reduces reliance on forms. Updating addresses with postal service data and allowing renewal by phone, online or text message makes it easier for people to respond. And allowing managed care plans and community organizations to help enrollees renew extends the state's reach.
Weighing the Trade-Offs
The policy choices involve real trade-offs. Supporters of frequent eligibility checks argue that Medicaid should cover only people who currently qualify, that states and the federal government should not pay for coverage of people whose incomes have risen and that regular verification protects program integrity. Supporters of continuous eligibility argue that incomes of low-wage workers fluctuate month to month, so frequent checks remove people who will soon qualify again, and that the resulting churn, losing and regaining coverage, costs states administrative money and disrupts care. Continuous eligibility does cost more in premiums paid to managed care plans for people who might otherwise have left the program. But procedural losses of people who remain eligible serve neither goal: they do not save money on anyone who should not be covered, and they create gaps and re-enrollment costs. That is why reducing procedural disenrollment has attracted support from states with very different views on Medicaid's size.
What Remains Unresolved
The problem is not solved. The unwinding showed that the renewal process itself can remove eligible people, and that problem persists every year. Federal legislation enacted in 2025 requires states to redetermine eligibility more often for adults covered through the Medicaid expansion and adds work reporting requirements for many of those adults beginning in 2027. More frequent checks and new reporting requirements increase the number of steps where eligible people can lose coverage, which the unwinding suggests could raise procedural disenrollment unless states automate verification. Whether states invest in ex parte processes, and whether federal policy continues to protect children through continuous eligibility, will shape coverage for years.
What Health Care Organizations Can Do
Hospitals, health centers and clinics have a direct stake. They can check patients' coverage status at every visit, help patients update addresses and complete renewals and partner with state agencies and plans on outreach. Many community health centers employ enrollment assisters who can help families like the one in the introduction regain coverage quickly.
Conclusion
The Medicaid unwinding showed that people can lose coverage not because they are ineligible but because of paperwork, outdated addresses and low awareness. Children, who are more often eligible, were particularly harmed where states relied on forms rather than data. Continuous eligibility, ex parte renewals and easier ways to respond reduced losses in some states. As eligibility checks become more frequent, whether policy keeps eligible people covered remains an open and pressing question.
References
Consolidated Appropriations Act, 2023, Pub. L. No. 117-328, 136 Stat. 4459 (2022).
Ding, D., Sommers, B. D., & Glied, S. A. (2024). Unwinding and the Medicaid undercount: Millions enrolled in Medicaid during the pandemic thought they were uninsured. Health Affairs, 43(5), 725-731. https://doi.org/10.1377/hlthaff.2023.01069
Eliason, E., Nelson, D., & Vasan, A. (2025). Continuous eligibility policies and CHIP structure affected children's coverage loss during Medicaid unwinding. Health Affairs, 44(3), 288-295. https://doi.org/10.1377/hlthaff.2024.01099
Families First Coronavirus Response Act, Pub. L. No. 116-127, 134 Stat. 178 (2020).
How this HCS 455 Week 4 example is structured
The HCS/455 shelf page describes Week 4 as moving to today's unresolved problems, from coverage gaps to workforce shortages. The paper takes one coverage problem that is recent, measurable and still changing, explains how federal and state policy produced it and weighs the responses. It keeps the focus on causes that policy can change, which is what separates a policy analysis from a description of a crisis. Students search this week as HCS 455 Week 4, HCS455 Wk 4 or HCS/455 Wk 4; all three are the same assignment.
HCS/455 Week 4 questions, answered
What does HCS/455 Week 4 usually ask for?
The HCS/455 shelf describes Week 4 as moving to today's unresolved health policy problems, such as coverage gaps and workforce shortages. Many sections ask students to analyze a current issue, its causes, its effects and possible policy responses.
What was the Medicaid unwinding?
During the COVID-19 public health emergency, states received extra federal Medicaid funding on the condition that they keep enrollees covered continuously. When that requirement ended on March 31, 2023, states resumed checking eligibility for every enrollee, a process called the unwinding, and millions lost coverage.
What is procedural disenrollment?
Losing Medicaid coverage for administrative reasons, such as not returning a renewal form or the state being unable to reach the enrollee, rather than because the state determined the person was no longer eligible. Many people disenrolled for procedural reasons were still eligible.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official University of Phoenix document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.