A "great unwinding" is very much underway in Medicaid programs nationwide, representing the most notable reversal of a government expansion since the welfare reforms of the 1990s.
From March 2020 to March 2023, Medicaid enrollment soared by more than 22 million people, a surge even larger than the Medicaid expansions brought on by the Affordable Care Act (ACA). This was primarily due to "continuous coverage" provisions in the coronavirus response that prevented states from conducting routine eligibility reviews—what bureaucrats call the redetermination process—which would ordinarily remove recipients who no longer qualify based on the objective, pre-established standards of need. At its recent peak, Medicaid covered almost 95 million Americans, a far cry from the original intent of protecting the most vulnerable.
