Historically, it has been common for people to churn in and out of the Medicaid program when states periodically attempt to verify that they remain eligible. During the COVID-19 pandemic, however, states paused redeterminations of Medicaid eligibility, and enrollment in the means-tested program grew to exceed 94 million people. States resumed redeterminations in April 2023, kicking off the so-called “unwinding” of continuous coverage—the single largest shock to insurance in the United States since the passage of the Affordable Care Act (ACA) in 2010.

As of July 2024, over 24 million Medicaid enrollees have lost their coverage; in New York state, which implemented a number of interventions to minimize coverage losses, 82 percent of redeterminations have resulted in renewals. It remains unclear—both in New York and nationally—how many people who lost Medicaid transitioned to other forms of coverage or have become uninsured.

A team of researchers at Weill Cornell Medicine, in collaboration with experts at the Harvard T. H. Chan School of Public Health, has launched the Medicaid Unwinding in New York (MUNY) Study, in part, to answer that question. The team will survey Medicaid enrollees in New York after their redetermination to examine their awareness of the unwinding, barriers to re-enrollment, availability of alternative coverage, and other enrollment outcomes. The study is led by Dr. William Schpero, assistant professor of population health sciences and co-associate director of the Cornell Center for Health Equity, and funded by the New York State Department of Health, United Hospital Fund, and Robert Wood Johnson Foundation.

Dr. Schpero will work with Dr. Kayla Tormohlen, senior research associate, and Mangala Rajan, research associate, at Weill Cornell Medicine, as well as Dr. Adrianna McIntyre and Dr. Benjamin Sommers of the Harvard T.H. Chan School of Public Health.

The team aims to gain insights on how to improve the renewal process so that people can better maintain their Medicaid coverage or efficiently transition to other forms of insurance, like subsidized private plans offered on the state insurance marketplaces established by the ACA.

“A big concern, one that pre-dates the current unwinding, is `procedural’ denials—people being denied coverage because they could not complete the renewal process, not because they were actually found ineligible for Medicaid,” Dr. Schpero explained. “We hope to provide guidance to states on ways to minimize procedural denials in the future.”

A key advantage of the study is that the research team will be able to compare Medicaid enrollees’ survey responses with administrative data from New York State on their enrollment in public programs.

“We have increasing evidence that a lot of people were enrolled in Medicaid, but were not aware of their continued coverage,” Dr. McIntyre said. “This work can help shed light on ways to make coverage more salient in the future; the many beneficial effects of public insurance may be limited if people aren’t aware they have access to it.”

The team also plans to examine differences in the effects of Medicaid unwinding across racial and ethnic groups. Early estimates from the US Department of Health and Human Services suggested that Medicaid enrollees from minoritized communities were disproportionately likely to face procedural denials and lose coverage.

“Researchers and policymakers have increasingly recognized how administrative frictions in our public programs can serve as barriers to access and compound existing inequities in access to care,” Dr. Schpero said. “We are really excited by the opportunity to leverage our analytic capabilities to inform the evolution of Medicaid policy in New York and nationally to enhance equity in the program.”