Understanding The Medicaid Unwinding And What It Means For You

What Is Medicaid Unwinding?


In January 2020, the federal government declared the COVID-19 pandemic a public health emergency (PHE) and lawmakers paused states’ annual review of Medicaid beneficiaries’ eligibility, meaning that nearly all Medicaid and Children's Health Insurance Program (CHIP) enrollees kept their coverage, regardless of changes in eligibility or status. As a result, Medicaid and CHIP membership grew to nearly 95 million people.1


Federal legislation signed on December 29, 2022 allowed states to begin initiating the Medicaid renewal process in February 2023, and begin removing ineligible members from their Medicaid programs starting April 1, 2023. This process is known as the “Medicaid Unwinding,” “Medicaid Renewal,” or “Medicaid Redetermination” and may result in millions of people losing their Medicaid or CHIP coverage.

How Many People Will Lose Medicaid Or CHIP Coverage?


An estimated 18 million people could lose Medicaid or CHIP coverage during the unwinding process.2 Current Medicaid beneficiaries should watch their mail for communications from their state Medicaid agency and provide requested information by the deadline to allow the state to determine if they are still eligible for Medicaid coverage. Learn more about the renewal process for Medicaid and CHIP coverage.


If the state determines that an individual is no longer eligible for Medicaid or CHIP the individual may be eligible for Medicare (if age 65 or older), or a health plan sponsored by their employer, or an affordable Anthem Individual and Family health plan available through the Affordable Care Act Health Insurance Marketplace (Marketplace).


Are Medicaid And CHIP Eligibility Guidelines Changing?


The eligibility guidelines for Medicaid and CHIP coverage are the same guidelines in place prior to the COVID-19 PHE. Typically, eligibility is based on income for those aged 19­­–64. Some individuals’ eligibility is determined based on disability or age (65 and older), rather than income. It’s important to note that eligibility guidelines may vary depending on the state where you live.


What Is The Highest Income To Qualify For Medicaid And CHIP In 2023?


Income qualifications depend on the size of the household. For an individual applying for Medicaid, the highest qualifying income is $14,580. For families up to eight, the highest qualifying income is $50,560. Families of four with household income up to $60,000 and children up to age 19 may qualify for CHIP. However, income and eligibility guidelines can vary by state.


Visit your state’s Medicaid agency website for specific income and eligibility qualifications based on where you live.


Your Next Steps To Prepare For The Medicaid Unwinding


To allow your state Medicaid agency to determine if you are still eligible for Medicaid or CHIP, make sure your personal information, including your current mailing address, phone number, email, and other contact details are up to date with the state. Also, watch your mail for communications from your state agency and be prepared to provide any information requested by the state before the applicable deadline, including updated information regarding your income.


If you no longer qualify for Medicaid or CHIP, you are eligible for a special enrollment period (SEP) for other coverage options. The length of the SEP will vary by state.


During this SEP, you may enroll in new healthcare coverage. Potential options include:

  • If you are age 65 or older, you may be eligible for Medicare coverage.

  • You may be eligible for coverage under a health plan sponsored by your employer.

  • You may enroll in a Marketplace plan. Individuals who enroll in Marketplace plans may qualify for financial help, including federal subsidies that can reduce your portion of monthly premiums as low as $0.* Individuals who purchase certain Marketplace plans may also qualify for cost-sharing reductions (CSRs), which are extra savings that reduce out-of-pocket costs by lowering your deductible, coinsurance or copays, and out-of-pocket maximum.

Learn more about cost-sharing reductions 



We Can Help You Navigate Your Health Insurance Options


You can rely on our experience and support to enroll in health coverage that meets your needs. If you’re no longer eligible for Medicaid or CHIP, learn more about your health coverage options to stay covered.

Find The Best Health Plan To Fit Your Needs

Learn which health insurance coverage and benefits you may qualify for today.


  1. KFF.org. March 2, 2023. As States Prepare to Resume Disenrollments, Medicaid/CHIP Enrollment Will Reach Nearly 95 Million in March, and the Pandemic Era Enrollment Growth of 23 Million Accounts for 1 in 4 Enrollees

  2. Urban.org. December 2022. The Impact of the COVID-19 Public Health Emergency Expiration on All Types of Health Coverage


Based on federal and/or state exchange requirements and subject to change. Anthem Blue Cross and Blue Shield and HealthKeepers, Inc. are Qualified Health Plan issuers that in certain geographic areas offers some health plans with a $0 or $1 premium option (after subsidy applied) through the Health Insurance Marketplace or your State Exchange. Health plans with a $0 or $1 premium option are not available in all areas and eligibility for these plans is based on federal annual income guidelines. Call us for information because not everyone will qualify. For example, singles earning up to $19,140, and couples earning up to $25,860, may be eligible. Family income eligibility varies based on number of family members.