Pandemic-era changes to medicaid enrollment and funding: Implications for future policy and research

Abstract

The COVID-19 public health emergency led to federal legislation that changed the landscape of Medicaid coverage for low-income people in the United States. Policy responses led to a surge in Medicaid caseloads due to new rules preventing Medicaid disenrollment, and total Medicaid enrollment increased more from 2020 to 2023 than the net increase in insurance coverage from 2013 to 2017 following the Affordable Care Act's implementation. It is crucial for scholars and practitioners to understand the implications of this continuous coverage policy and its 2023–2024 unwinding. This paper provides an overview of Medicaid enrollment, renewal, and funding policies, highlighting how policy changed during and immediately following the acute phase of the pandemic; describes enrollment increases and their composition; reviews relevant literature; and identifies key areas for research. By examining this unprecedented period in Medicaid, we can inform future policy decisions and optimize safety net programs to be effective under a broad set of circumstances.