Medicaid unwinding's effects on dual-eligible individuals, mapped

This story was originally published on the Penn LDI website and written by Julia Hinckley, J.D.

When states resumed eligibility reviews for Medicaid enrollees after the COVID-19 pandemic, people who are dually eligible for Medicare and Medicaid would seem likely to remain eligible. These seniors and people with disabilities often live on fixed incomes that are unlikely to increase enough to make them ineligible.

But when Eric T. Roberts, his colleague Renuka Tipirneni, and other collaborators at the University of Michigan and Michigan’s Institute for Health Policy Innovation (IHPI) conducted a first-of-its-kind study examining dually eligible individuals’ experience with the “unwinding” of the pandemic-era pause, they found that nearly one in seven low-income Medicare beneficiaries lost all Medicaid coverage for at least one month from April 2023 to September 2024.

And most of those didn’t make it back during the study period. Fewer than one-third of those who lost coverage re-enrolled within six months. Medicaid disenrollment rates varied across states, beneficiary subgroups, and types of Medicare coverage, likely reflecting differences in state policies affecting the stringency or complexity of redeterminations.

Disruptions in coverage can have significant consequences for older adults with greater care needs, including deteriorating health, a reduced ability to remain at home, and increased risk of mortality.

This evidence highlights potential points of failure in the redetermination process that can trigger Medicaid disenrollment for procedural reasons rather than improved finances.

Understanding which groups are at the highest risk of losing coverage will be critical as states implement the provisions of the One Big Beautiful Bill Act, including delays in implementing streamlined Medicaid eligibility processes for dually eligible beneficiaries.

The authors recommend that a multi-pronged approach may be necessary to keep eligible people enrolled: outreach by Medicare Advantage (MA) plans, funding for insurance counselors, and expanded use of automatic Medicaid eligibility determinations with data from other means-tested programs, known as ex parte renewals.

The article, “Disenrollment Rate For Dual-Eligible Beneficiaries During Medicaid Unwinding, 2023–24,” was published on March 2, 2026 in Health Affairs. Authors include Eric T. Roberts, Dominic Ruggiero, Syama Patel, John Z. Ayanian, Erin Beathard, Matthias Kirch, Jeffrey T. Kullgren, Galen Switzer, and Renuka Tipirneni.