Community Health Centers Report The Impact of Medicaid Unwinding a Year Later

Analysis finds nearly one quarter of community health center patients who rely on Medicaid lost coverage

April 10, 2024

A stethoscope and patient file

WASHINGTON (April 10, 2024)During the COVID-19 public health emergency, states were incentivized under the Families First Coronavirus Response Act to keep Medicaid beneficiaries continuously enrolled in exchange for a substantial increase in federal funding. When this special continuous enrollment guarantee ended in 2023, states began the process of returning to the normal eligibility redetermination process, known as Medicaid “unwinding”. To date, 70 percent of all people who have lost coverage have been disenrolled not because they were determined to be ineligible, but because they were unable to navigate the renewal process.

According to new analysis from the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at the George Washington University Milken Institute School of Public Health, community health centers, which serve 31.5 million patients nationwide, are seeing a significant impact one year later.

The analysis, based on a national survey of community health centers fielded by the National Association of Community Health Centers and The George Washington University’s Geiger Gibson Program in Community Health in January - February 2024, found that:

  • Nearly all health centers (95 percent) report that patients have been disenrolled, with nearly one in four patients losing coverage. 
  • Only about one quarter of disenrolled patients have been successfully re-enrolled in Medicaid. Three quarters of those who lost their Medicaid coverage remain disenrolled. Because health center patients are deeply impoverished, the likelihood that they have secured private insurance coverage is relatively low.
  • Older adults over age 65 constituted 12 percent of those community health center patients who lost Medicaid coverage. An estimated 32 percent were patients with chronic conditions, while 12 percent were persons with disabilities.
  • Twenty-four percent of disenrolled community health center patients, on average, were children, and in health centers located in non-expansion states, 40 percent were children.

Coverage losses are leading to disruptions in care, further suggesting that many patients losing Medicaid have not been able to secure other coverage. Nearly two-thirds of respondents (63 percent) reported that patients had problems securing needed health care, while more than half reported treatment interruptions as a result of the coverage loss.

“Health centers are sounding the alarm on unwinding with nearly a quarter of their Medicaid patients, including children and older adults, losing coverage,” said Peter Shin, Research Director of the Geiger Gibson Program. “The reported proportion of patients who are not seeking care or continuing treatment is also substantial and highly concerning.”

If these trends remain consistent as unwinding continues into 2024, with an estimated one in four  community health center Medicaid  patients being disenrolled, then coverage disruptions can be expected for more than 3.5 million community health center  patients, based on 2022 estimates of Medicaid-insured patients.

The analysis, “One Year After Medicaid Unwinding Began, Community Health Centers, Their Patients, and Their Communities are Feeling the Impact,” was authored by researchers at the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at the GW Milken Institute School of Public Health.