Publication date: Jul 30, 2025

To investigate the effect of the unwinding of the pandemic-related continuous Medicaid enrollment provision on health insurance coverage and economic hardship. The termination of the continuous Medicaid enrollment provision during early 2023 and the subsequent state-level resumption of the standard renewal process prompted large-scale Medicaid disenrollments nationwide. Using state-month variation in the incidence of the first round of disenrollments, we estimate the effects of the unwinding process on health insurance coverage, including Medicaid enrollment, and the likelihood of experiencing economic hardship for the adult population. We use state-level monthly Medicaid enrollment data from the Centers for Medicare and Medicaid Services and self-reported individual-level indicators of Medicaid coverage, being uninsured, and economic hardship from the U. S. Census Bureau’s Household Pulse Survey. Our key findings are substantiated by evidence drawn from recent annual data from the Current Population Survey and the Survey of Household Economics and Decisionmaking. States’ unwinding of the continuous Medicaid enrollment provision reduced state-level Medicaid enrollment by 4% [-0. 071-0. 004]. We do not, however, find statistically significant effects on changes in the probability of being without any health coverage and experiencing economic hardship for the overall adult population. However, further evidence reveals that the effects can be heterogeneous depending on demographic and educational characteristics. The unwinding of the continuous Medicaid enrollment provision reduced overall Medicaid enrollments. However, there is no evidence that these provisions changed the probability of being uninsured and experiencing economic hardship for the general adult population. This study opens an important research scope for investigating the long-term implications of unwinding large-scale pandemic-related relief measures.

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