MAGA state boots nearly 2 million people off Medicaid

Almost 1.8 million people in Texas have been removed from Medicaid health coverage over the past two years, according to data from KFF, a nonprofit health policy research and news organization. Knewz.com has learned that the losses are part of a nationwide “unwinding” process following the end of continuous Medicaid enrollment measures implemented during the COVID-19 pandemic.

Working to make sure eligible candidates continue to get benefits

The Texas Health and Human Services Commission (HHSC) said in a statement it is working with federal authorities to make sure eligible residents continue to get benefits. “Federal guidance required HHSC to redetermine eligibility for 6 million Medicaid clients over the course of 12 months,” a spokesperson from the HHSC said. “Redetermining eligibility within federal requirements was a massive undertaking. Throughout the unwind, HHSC met with our federal partners on a regular basis to ensure that we followed federal guidance, and we will continue to collaborate with CMS [Centers for Medicare & Medicaid Services] to provide eligible Texans with benefits.”

‘Unwinding’ process leads to significant drops in enrollment

It has been reported that the unwinding process has led to large drops in Medicaid enrollment across the U.S. While some disenrolled individuals may still have access to other forms of health coverage such as employer-based insurance, many face the possibility of becoming uninsured. Research has shown that having a higher rate of uninsured residents is linked to worse health outcomes and increased medical costs. According to reports, Texas’ nearly 1.8 million disenrollments represent a faster rate of decline than in Florida, California or New York. Current Medicaid enrollment in Texas now sits just below February 2020 levels, a difference of about 1%.

Medicaid enrollment steadily dropped since March 2023

During the COVID-19 pandemic, several states expanded Medicaid under the Affordable Care Act (ACA), and many Americans signed up for coverage amid heightened health concerns. Federal policy at the time required states to keep most Medicaid participants enrolled, even if they no longer met eligibility criteria. This rule ended in March 2023, allowing states to once again remove individuals from the program. Since then, Medicaid enrollment has steadily dropped due to both loss of eligibility and procedural removals. In Texas, enrollment fell from 5,922,450 in March 2023 to 4,164,694 by March 2025, according to KFF data.

Why Texas saw steeper losses

Several factors contributed to Texas’ sharper drop, according to Timothy McBride, professor of public health at Washington University in St. Louis. He said in a statement that Texas, Florida, California and New York together accounted for 36% of Medicaid enrollment before the unwinding and 31% of the enrollment decline between 2020 and 2025. While these states have large populations, McBride noted they also have “some of the lowest percentages of health insurance coverage by employers or private plans.” Contributing factors include “higher poverty rates, especially in Florida and Texas, fewer good jobs that offer health insurance, and a higher percentage of nonwhite persons, especially in Florida, Texas and California,” he said, adding that “if they do not have private coverage, they seek Medicaid.” McBride went on to say that he is “worried about” those that may remain uninsured as a result of the unwinding process. “The negative outcomes could be delays in seeking needed medical care leading to worse outcomes, lack of prevention, which is especially problematic if they have chronic conditions, bad mental health and financial outcomes, and higher medical debt [because] they have to pay for more out of pocket,” he said.

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