The expiration of pandemic-era health care protections has led to a significant decline in public insurance enrollment in California, with more than 850,000 residents losing Medicaid or Children’s Health Insurance Program (CHIP) coverage since the redetermination process resumed in March 2023.
Declining Enrollment in California
According to data from KFF, a nonprofit health policy research group, California’s public insurance enrollment fell from approximately 14.3 million to 13.4 million over an 18-month period ending in October 2024. This reduction is part of a nationwide Medicaid and CHIP disenrollment process that began following the rollback of COVID-era continuous coverage protections.
Although California’s 6% drop in enrollment is lower than what has been seen in states like Florida and Texas, the loss of coverage for nearly a million residents remains a pressing concern. Reports suggest that many individuals lost coverage not because they were ineligible, but due to confusion surrounding the unwinding process and administrative hurdles that prevented them from renewing their benefits.
How We Got Here: The End of Continuous Enrollment
During the pandemic, the Families First Coronavirus Response Act (FFCRA) included a “continuous enrollment” provision, which prevented states from disenrolling Medicaid and CHIP beneficiaries while the public health emergency remained in effect. As a result, enrollment surged by approximately 13 million people nationwide before redeterminations were reinstated in March 2023.
Once the COVID-era protections expired, many Medicaid recipients were required to reconfirm their eligibility to maintain coverage. However, surveys conducted by KFF found that many enrollees were unaware of the changes, and procedural issues—such as delays, administrative errors, and miscommunication from state agencies—led to widespread disruptions in coverage.
How California Fared Compared to Other States
Disenrollment rates have varied across the country due to differences in how states handled the Medicaid renewal process.
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Some states, such as Pennsylvania, opted for aggressive disenrollment measures, flagging individuals as “likely ineligible” to expedite removals. Other states, including California and Oregon, sought to minimize coverage losses through automatic renewal programs (ex parte renewals), allowing eligible individuals to retain coverage without requiring extensive paperwork.
Thanks to these efforts, California’s disenrollment rate remains lower than the national average, with the state still maintaining 1.8 million more Medicaid and CHIP enrollees than before the pandemic—a 16% increase compared to February 2020.
Concerns Over Coverage Losses
Despite California’s relatively lower disenrollment rate, health care advocates remain worried about the large number of people losing access to care.
Ben Anderson, deputy senior director of health policy at Families USA, pointed out that while some states made strides in preserving coverage, others allowed preventable disruptions.
“We have seen some amazing coverage expansion in places like Oregon and California,” Anderson said in September 2024. “But if you live in Texas, Florida, or Georgia, your health coverage has been disrupted in ways that state leaders could have prevented.”
What’s Next for Medicaid and CHIP Enrollees?
With most of the unwinding process nearing completion, KFF reports that some states may still be finalizing Medicaid eligibility determinations. However, efforts to increase awareness and improve outreach remain crucial in ensuring that eligible individuals do not lose coverage due to procedural issues.
For those affected, experts recommend checking eligibility requirements, staying informed on renewal deadlines, and seeking assistance from health advocacy organizations to navigate the Medicaid re-enrollment process.
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