The great Medicaid “unwinding” is upon us. Behavioral health patients around the country are about to be “kicked off” Medicaid thanks to new federal shifts in Medicaid policy as the COVID-19 pandemic continues to wane. As enrollees come under increasing scrutiny, it will be up to the individual states to determine the fate of the people who no longer qualify for Medicaid. In states that have not yet chosen to adopt Medicaid expansion, a large “coverage gap” threatens to render many former Medicaid enrollees uninsured and without many options.

Today, let’s examine the likely outcome of Medicaid unwinding on behavioral health patients in California, Florida, Ohio, Texas, Pennsylvania, Michigan and Georgia. 

California Medicaid Unwinding: More Medicaid Patients Than Any Other State 

California has more Medicaid patients than any other state in the union. With over 15 million enrollees in the so-called Medical program, the unwinding tasks that lay before the Golden State are truly herculean. Each of these enrollees will need to be re-processed so that their applications can be checked to ensure that they still meet income requirements for Medicaid.The state currently has an “all-time low” rate of uninsured, with only 7% of Californians going completely without any health coverage. That is likely to change as the unwinding continues. 

Florida State Medicaid Redetermination Plan Threatens Millions of Enrollees at Unwinding

Florida’s Medicaid Redetermination Plan outlines how the Sunshine State will respond to the Medicaid unwinding project. In Florida, the unwinding process is estimated to take 12 months start to finish. Patients will begin receiving redetermination letters with yellow stripes on them beginning March 31.

Florida saw a huge increase in the number of Medicaid enrollees during the pandemic. They ballooned from 3.8 million in March 2020 to 5.5 million in November of that same year. Florida believes that only 4.9 of the 5.5 million are truly qualified for the program and plans to winnow the number of Medicaid patients back down to that number through eligibility reprocessing.

Ohio Medicaid Unwinding Renewal Packet Must be Completed in 2023

Ohio began reprocessing Medicaid applications in February 2023. The state released an FAQ about the Medicaid unwinding and resuming eligibility operations. In it, Ohio is doing an auto renewal program, which they hope will reduce the number of people who get “kicked off” Medicaid in the wake of shifting federal guidelines. That said, applicants must still complete a renewal packet and send it to the appropriate party. 

Texas Medicaid Unwinding: Adopting Medicaid Expansion Would Make This a Better State for Behavioral Health

Texas’ Health and Human Services has a page dedicated to information for people who are experiencing the end of their continuous Medicaid coverage. 

Texas is one of the 10 states that has still not adopted Medicaid expansion. This means that as Texans have their Medicaid application reprocessed during the unwinding process, they are vulnerable to an existing “coverage gap” between state and federal resources for health insurance. In these cases, sometimes ex-enrollees are ineligible for federal marketplace subsidies because they make too little money while also ineligible for state assistance because they make too much money to meet the states’ artificially low income requirements. 

Pennsylvania Almost Chose Shortened Medicaid Unwinding Timeline

Pennsylvania originally intended to execute the entire unwinding process in just six months, but later changed its mind and decided to embrace a more standard 12 month plan when advocates complained that the truncated timeline might be overly punitive to enrollees. 

In Pennsylvania, enrollment will be reprocessed at the time that your plan expires. About a month before that point, a renewal packet which you must complete will arrive in the mail. The Pennsylvania Department of Human Services will also be texting enrollees to let them know that their renewal packet is in the mail. 

Pennsylvania maintains an excellent question and answer page about the unwinding. 

Michigan Medicaid Unwinding to Follow a Three Month Plan

In Michigan, roughly one-third of the state’s population, over 3 million people, receives some form of Medicaid. This year, the state is pushing all 3.17 million Michiganders through a “reassessment” to verify that they still meet income requirements for the state subsidized program. 

The state has committed to a “three month” plan, where enrollees will get a letter explaining the change in policy in the month before they were first enrolled in Medicaid. The following month, those patients will receive a packet in the mail. After that, you’ll have another month to complete the paperwork and return it to the state. All together, the process is slated to take up to 14 months. 

Georgia Medicaid Unwinding Will Affect 3 Million People

There are nearly 3 million people in Georgia who are on Medicaid or PeachCare for Kids. Many of those enrolled will lose their coverage as the state begins the Medicaid unwinding process. 

Georgia has not adopted Medicaid Expansion, which means that the enrollees who are being reprocessed during the unwinding are at higher risk of falling through the “coverage gap” between state and federal health insurance assistance. 

Georgia is also facing staffing issues as they scramble with finding enough eligibility workers to tackle reprocessing almost 3 million applications. 

In this perfect storm, we can expect to see many Georgians lose their coverage without many options for moving forward or getting the healthcare they deserve. 

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