Which States Were Furthest Along in Medicaid Unwinding in 2023?

We recently released a report looking at state performance during the Medicaid unwinding with a focus on children. We examined data from the beginning of the unwinding, which varies by state, through the end of 2023. Some states (7) acted very cautiously and saw very little to no change in their net child Medicaid enrollment during 2023. Other states moved hastily and saw large numbers (TX, FL, GA) or rates (SD, MT, UT) of disenrollment of children.

The chart below allows you to put a state’s child enrollment decline data into greater perspective by seeing how far along in the Medicaid unwinding process your state was by the end of 2023.  It is useful to compare this to our state data tracker on net decline in child Medicaid enrollment to get a sense of how further child enrollment is expected to drop.

Of the top three states with the largest number declines, Texas had the largest reduction in child enrollment with over one million fewer children enrolled in Medicaid and CHIP after completing 70% of the unwinding process. Florida was next with 589,000 fewer kids enrolled three-quarters of the way through the process. Georgia comes next and was already down by 300,000 children only halfway through the process, so it’s reasonable to expect many more Georgia children to be disenrolled during the second half of the unwinding process in that state.

With respect to states with high rates of child Medicaid/CHIP enrollment declines, South Dakota was 78 percent done with unwinding at the end of 2023, Montana was 79 percent finished, and Utah was 65 percent done. It is concerning that all of these states have likely had more child enrollment declines in 2024 since they were so high already.

In good news, Connecticut was the furthest along in the unwinding process (88% complete) and had 0% change in its child Medicaid/CHIP enrollment. Ohio also stands out as a state that despite pressure from the legislature and a county-based system which adds complexity has done a very careful job of disenrollment with respect to kids.

As of this writing we are waiting for CMS to publish a chart with updated information on state unwinding end dates. Originally, all states were supposed to finish the process by June 2024 but because of various flexibilities CMS has offered, as well as challenges that have emerged like the ex parte glitch, some states are taking longer.

[Editor’s Note: The enrollment report includes Medicaid and CHIP enrollment data, while the state data tracker is based on Medicaid (which may include M-CHIP) enrollment data. Special thanks to Aubrianna Osorio and Jade Little for their data analysis expertise.]

Joan Alker is the Executive Director of the Center for Children and Families and a Research Professor at the Georgetown McCourt School of Public Policy.