Original Investigation

US Coverage Changes During Medicaid Unwinding in 2023

JAMA Health Forum 10.1001/jamahealthforum.2025.3887

October 10, 2025 at 11:00 AM EDT

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How did coverage losses during unwinding of the Medicaid continuous coverage provision vary across different measures, states, and demographic groups?In this cross-sectional study, net Medicaid enrollment loss during unwinding varied substantially across states and was lower than the sum of terminations during this time. Coverage losses were concentrated among several demographic groups, with healthier individuals more likely to become uninsured and report barriers accessing care.Discrepancies between disenrollments and net losses reflect both churn and coverage transitions; state variation observed during unwinding may inform expectations about pending Medicaid reforms.

Corresponding Author: Adrianna McIntyre, PhD, MPP, MPH, Harvard T.H. Chan School of Public Health, Harvard Medical School, 677 Huntington Ave, Boston, MA 02115 (amcintyre@hsph.harvard.edu).

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