What Will Happen to Unprecedented High Medicaid Enrollment After the Public Health Emergency?

Patients complete paperwork in a waiting room.

Following unprecedented Medicaid enrollment during the public health emergency, analysis projects that 15 million people could lose Medicaid coverage when the emergency declaration ends.

The Issue

Medicaid enrollment has risen substantially since the start of the COVID-19 pandemic, driven by unprecedented pandemic-related job losses and the continuous coverage requirement of the Families First Coronavirus Response Act.

Key Findings

Researchers at the Urban Institute report that states have the power to slow the pace of this disenrollment and can provide assistance finding alternative coverage options for these individuals. Additional findings include:

  • The continuous coverage requirement of the Families First Coronavirus Response Act, which prohibited state Medicaid agencies from disenrolling beneficiaries during the public health emergency, would increase Medicaid enrollment by an estimated 17 million people from the start of the pandemic to the expected expiration of the PHE at the end of 2021, reaching a total of 76.3 million Medicaid enrollees under age 65.

  • One-third of adults losing Medicaid coverage in 2022 would be eligible for Marketplace premium tax credits if the enhanced tax credits in the American Rescue Plan Act were made permanent.

  • Of the children losing Medicaid in 2022, 57 percent would be eligible for the Children’s Health Insurance Program, and an additional 9 percent would be eligible for Marketplace coverage with tax credits.


Researchers report that state efforts to assist enrollment and coordinate between Medicaid and the Marketplaces will be essential to ensure that these people have access to affordable coverage options. Expanding access to affordable and comprehensive healthcare will significantly move the nation closer to reducing long-standing racial and ethnic health disparities that were exacerbated by the pandemic.

About the Urban Institute

The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector. Visit the Urban Institute’s Health Policy Center for more information specific to its staff and its recent research.