Experiences with Medicaid unwinding among low-income adults in 4 southern states

After states initiated Medicaid redeterminations following the end of the Medicaid continuous coverage provision, millions of people lost Medicaid coverage. To date, there is limited evidence evaluating how people experienced this "unwinding" process. Using a survey of low-income adults in 4 southern states, we assessed awareness of unwinding, experience with state-based outreach, and understanding of coverage changes. Over half of respondents with some Medicaid enrollment experience (57%) reported having heard "a little," "some," or "a lot" about unwinding, with media as the most common source of information. Among respondents who reported losing Medicaid coverage, 55% reported that they thought this was because they were no longer eligible. The majority of those who lost Medicaid found out they had been disenrolled after communication from the state, but about one-quarter learned while trying to seek care. Last, nearly 50% of respondents reported losing coverage prior to April 2023, before the unwinding process began. Incomplete awareness of unwinding among people with Medicaid enrollment and confusion about enrollment status and termination timing underscore an imperative for clear communication about Medicaid benefits, particularly considering recent policies extending 12-month continuous coverage to children and postpartum enrollees. Additionally, policymakers may wish to consider new opportunities and strategies to provide enrollment resources at sites of clinical care (including pharmacies) when people unexpectedly learn about coverage loss at the point of service.