California has seen a significant drop in public insurance coverage, with over 850,000 people losing Medicaid and CHIP coverage since March 2023. This decline follows the expiration of COVID-19-era continuous enrollment policies, which had temporarily prevented states from disenrolling recipients.
A Nationwide Trend in Medicaid Disenrollment
The “unwinding” process, which began in early 2023, has affected Medicaid enrollees across the country. In California, Medicaid and CHIP enrollment fell from 14.3 million to 13.4 million in the 18 months leading up to October 2024, according to KFF, a nonprofit specializing in health policy research.
Compared to other large states like Texas and Florida, where disenrollment rates have been much higher, California’s 6 percent decline is relatively moderate. KFF data shows that 19 percent of those disenrolled in California were unable to renew their coverage, compared to a national average of 31 percent.
Despite this, nearly 1 million Californians now face uncertainty regarding their health care coverage. Many of those who lost coverage were still eligible but were unable to navigate the complex renewal process due to confusion, administrative errors, and state communication failures.
Why Medicaid Enrollments Surged—and Then Fell
During the COVID-19 pandemic, Congress passed the Families First Coronavirus Response Act, which included a continuous enrollment provision preventing states from removing individuals from Medicaid and CHIP. This provision led to an increase of 13 million enrollees nationwide, including in California.
However, when continuous enrollment ended in March 2023, the redetermination process resumed. Many enrollees were unaware of the change, leading to delayed renewals, procedural roadblocks, and widespread coverage losses.
California’s Approach to Mitigating Coverage Losses
Unlike some states that took an aggressive approach to removing people from Medicaid, California attempted to minimize procedural disenrollments. The state used ex parte (auto-renewal) initiatives to ensure eligible individuals kept their coverage without requiring them to reapply manually.
As a result, while 850,000 Californians lost coverage, this number was far lower than some earlier projections. Additionally, overall Medicaid and CHIP enrollment remains 1.8 million higher than it was before the pandemic in February 2020.
What’s Next for Public Insurance in California?
The unwinding process is largely complete, but its effects will continue to be felt by those who lost coverage. Health care advocates warn that many people may remain uninsured simply because of procedural obstacles rather than actual ineligibility.
Ben Anderson, deputy senior director of health policy at Families USA, highlighted the disparity between states, telling KFF Health News:
“We have seen some amazing coverage expansion in places like Oregon and California. But if you live in Texas, Florida, and Georgia, since the pandemic your health coverage has been disrupted in ways that were preventable by state leaders.”
California’s next challenge will be ensuring that eligible individuals who lost coverage can re-enroll, while continuing efforts to streamline Medicaid renewal processes to prevent unnecessary disenrollments in the future.
