Paragon Health Institute Icon White
Paragon Pic

Medicaid Unwinding Drove 77 Percent of Increased Exchange Plan Selections in 2024

5dg UnwindingvOpenEnrollment
Drew Gonshorowski
Senior Research Fellow at Paragon Health Institute

Drew Gonshorowski is a Senior Research Fellow at Paragon Health Institute. He brings a decade of experience conducting quantitative research and building models examining health policy and entitlement programs.

Between the 2023 and 2024 Affordable Care Act (ACA) open enrollment periods, 5.1 million more people selected an exchange plan. As a previous Paragon Pic shows, this increase in enrollment was driven by enrollees eligible for coverage where taxpayers bear the entire cost of the plan.

This week’s Pic shows that in 2024, 77 percent of the increase in exchange enrollment came from the Medicaid unwinding population- Medicaid enrollees kept on the rolls despite being ineligible as a result of states not being allowed to remove them from the program during the COVID public health emergency (the continuous coverage provision in the Families First Coronavirus Response Act).

In April 2023, states began conducting Medicaid eligibility reviews and removing ineligible recipients. The Center for Medicare and Medicaid Services (CMS) tracks how many from the unwinding population transition to ACA exchange coverage. CMS reports that from April 2023 to January 2024 in all states, 3.9 million people who were no longer eligible for Medicaid coverage selected a plan on the exchanges.

As of January 2024, CMS reports that 14.8 million individuals were disenrolled from Medicaid or CHIP. Over 26 percent of the unwinding population selected a plan on the exchanges, a much higher percentage than projected by the Urban Institute (only 6 percent) and Ding et al. in Health Affairs (only 15 percent). Even more of those who were ineligible for Medicaid were already enrolled in an employer plan or are eligible for an employer plan.

As a result of the American Rescue Plan Act and Inflation Reduction Act, people making under 150 percent of the federal poverty level qualify for a fully-taxpayer subsidized benchmark plan which also has extremely low cost-sharing. Fully subsidized plans and the Medicaid unwinding are clearly driving the record enrollment in Exchange plans.

Related Research

No results found.