The Medicaid Unwinding

In This Section

Understanding the Medicaid Unwind

Frequently Asked Questions

As part of its COVID-19 response efforts, Congress passed the Families First Coronavirus Response Act on March 18, 2020. This bill includes enhanced federal funding for state Medicaid agencies to provide care throughout the duration of the federal public health emergency (PHE). As a condition of receiving this enhanced federal funding, states were prevented from terminating people’s Medicaid coverage in most circumstances. This continuous coverage requirement was designed to ensure that people did not lose their health insurance during the pandemic and has resulted in significant growth in Medicaid enrollment and contributed to the national uninsured rate reaching an all-time low in 2022.
On December 23, 2022, Congress passed the Consolidated Appropriations Act of 2023, which set an end date for the continuous coverage requirement. Under the law, state Medicaid agencies can begin processing Medicaid eligibility terminations as early as April 1, 2023, and will complete redeterminations for all members within 14 months. During this period, 5–14 million people nationwide are expected to lose Medicaid coverage. Of those, up to 7 million people will erroneously lose Medicaid coverage despite ongoing eligibility.
As the largest payer for maternity care in the United States, Medicaid plays a crucial role in the delivery of obstetric and gynecological services. During the PHE, pregnant people who were eligible for Medicaid saw the largest percentage increase in enrollment of any eligibility category, with approximately 64% more beneficiaries in April 2022 compared to February 2020. A growing body of research suggests that unsafe gaps in health insurance coverage exacerbate poor maternal health outcomes and cause people to forgo postpartum care.

Medicaid coverage during the unwinding will vary significantly depending on the state. Additionally, more than 28 states and Washington, D.C., have taken up the 12-month postpartum coverage option, with several more expected to extend postpartum coverage soon. Pregnant people in states that have taken up the option will have 12 months of Medicaid coverage from the date of their delivery regardless of where their state is in the unwinding process. However, those in states that have not elected to extend postpartum coverage may lose coverage 60 days after delivery as early as this spring. For more information about the current status of postpartum coverage in your state, see ACOG’s resource on the status of state actions to extend postpartum Medicaid coverage.

Obstetricians and gynecologists should encourage their patients to update their mailing address and contact information with their state Medicaid agency and respond to verification requests from the Medicaid agency. See the chart below for additional state guidance.

The Medicaid Unwinding

Understanding the Medicaid Unwind

Frequently Asked Questions

Extend Postpartum Medicaid Coverage

More Information on the Medicaid Unwinding

Resources for Your Practice

Resources for Patients

State Resources

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