What Will Happen to Medicaid Enrollees' Health Coverage After the Public Health Emergency?

Updated Projections of Medicaid Coverage and Cost

A man fills in a form at the reception area of a Department of Children and Family Serices office.

Medicaid enrollment has risen to unprecedented levels since the start of the COVID-19 pandemic, but millions of people could lose their Medicaid coverage when the Department of Health and Human Services’ COVID-19 Public Health Emergency (PHE) expires.

The Issue

The COVID-19 pandemic and federal mitigation efforts led to unprecedented Medicaid enrollment, largely thanks to the Medicaid continues coverage requirement, which prevents state Medicaid agencies from disenrolling beneficiaries during the PHE. One of the most urgent issues facing policymakers is what happens to the health coverage of these millions of new enrollees after the PHE ends.

Key Findings

  • Researchers found that nearly 13 million people (12.9M) would lose coverage if the PHE expires after the first quarter of 2022. After the second quarter, more than 14 million people (14.4M) are expected to lose coverage, and nearly 16 million (15.8M) if the PHE expires after the third quarter of 2022.

  • The Medicaid continuous coverage requirement has provided stable health coverage to millions of people and helped prevent the number of uninsured people from increasing in the wake of pandemic job losses.

  • People losing Medicaid coverage risk becoming uninsured. While many would likely be eligible for other subsidized health insurance coverage, these plans may cost more, preventing eligible individuals from enrolling. If Congress does not extend the enhanced premium tax credits from the American Rescue Plan Act, cost will pose an even greater barrier.

  • Eligible people could be unnecessarily disenrolled from Medicaid and become uninsured, as the unprecedented volume of eligibility determinations strains states’ processing systems.


The Medicaid continuous coverage requirement has provided stable health coverage to millions of people during the pandemic, but the longer it lasts, the more people will be affected after it ends. Researchers say states must prepare now to minimize inappropriate disenrollment and losses of health coverage.

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.