By: Nathaniel Greene, Community & Culture Reporter

The nation’s largest health insurance program, Medicaid, which provides free or low-cost coverage to over 83 million people in the United States, is now facing a massive crisis. Following the end of the pandemic-era continuous coverage protections – dubbed “the great unwinding” – 23 million people, including three million children, have either lost or are at risk of losing coverage. Strikingly, 69% of these individuals were not disenrolled due to ineligibility but rather due to paperwork and procedural hurdles. This issue is now more pressing than ever, especially in light of the current election climate, where healthcare policies are at the forefront of political debates.

Medicaid Under Siege: The Disastrous Impact of the “Great Unwinding”

Medicaid, a federal-state partnership program, is the country’s largest single source of health insurance, covering one in four Americans, including nearly half of all children in the United States. However, the end of continuous coverage protections has led to what experts are calling a “great unwinding,” resulting in a catastrophic loss of coverage for millions.

Katherine Hempstead, Senior Policy Adviser at the Robert Wood Johnson Foundation, opened the recent Ethnic Media Services briefing on Aug. 9 by highlighting the severity of the crisis.

“Medicaid touches almost everyone in the country, but it is now in jeopardy due to a combination of administrative inefficiencies and deliberate policy decisions,” she emphasized. “This is not just about numbers; it’s about real people losing their healthcare over paperwork errors.”

She further stressed, “States have a duty to ensure their citizens have access to healthcare, yet 10 states, primarily in the South, continue to refuse to expand their Medicaid programs under the Affordable Care Act. These states have some of the worst health inequities in the nation.”

The Devastating Effects on Communities of Color

Stan Dorn, Director of the Health Policy Project at UnidosUS, provided a stark overview of the racial and ethnic disparities exacerbated by the unwinding.

“Communities of color are bearing the brunt of these disenrollments,” he said. “Our conservative estimates suggest that nearly four million Latinos and three million African Americans have lost Medicaid coverage. These losses are greater than any previous one-year drops in Medicaid history.”

Dorn pointed out that the vast majority of these disenrollments are due to administrative barriers, not eligibility issues.

“Less than a third of those terminated were actually found ineligible. The rest lost coverage because of red tape—paperwork, lost documents, or simply not receiving notices,” he explained. “We need to eliminate these administrative burdens and create a system that prioritizes keeping people insured.”

A Generation at Risk: Young People and Medicaid

Martha Sanchez, Health Policy and Advocacy Director at Young Invincibles, highlighted the particular challenges faced by young adults aged 18 to 34.

“Young adults remain the highest uninsured population of any age group and make up 47% of the Medicaid coverage gap,” Sanchez noted. “Many are transitioning out of childhood Medicaid coverage, and the lack of health literacy, combined with procedural barriers, prevents them from maintaining insurance.”

She added, “We know that half of young adults aged 18 to 24 are facing a mental health crisis. Yet many are unaware of the mental health benefits available to them through Medicaid, even when they remain eligible. We need policies that promote health literacy and ensure young people know how to access the healthcare they need.”

The Call for Policy Change and Immediate Action

Joan Alker, Executive Director of the Center for Children and Families, emphasized the urgent need for federal and state action to mitigate the crisis. “We predicted that 6.7 million children would have a gap in coverage, and we are now seeing a decline of five million fewer children in Medicaid,” she warned. “Many of these children are still eligible but remain unenrolled due to bureaucratic barriers.”

Alker called for community-level action, stating, “If you’re working with communities, especially in states like Texas, Florida, and Georgia, where disenrollment rates are highest, we need to get the message out. Many of these children are still eligible for Medicaid or CHIP, and we must do everything possible to get them re-enrolled.”

Bridging the Gap: A Need for Nationwide Medicaid Expansion

The speakers agreed that one of the most significant steps toward resolving these issues would be the expansion of Medicaid in the 10 remaining non-expansion states.

“Expanding Medicaid is the most significant way to increase coverage rates and achieve health equity, especially after this unwinding,” said Hempstead. “It is imperative that states act now to close the coverage gap that disproportionately affects communities of color.”

As Medicaid continues to unravel in many states, the question remains: Will policymakers act in time to protect millions of Americans from falling through the cracks of the nation’s largest health safety net?