{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T16:34:07Z","timestamp":1783355647430,"version":"3.54.6"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2025,4,16]],"date-time":"2025-04-16T00:00:00Z","timestamp":1744761600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000905","name":"The Commonwealth Fund","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000905","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100019234","name":"Episcopal Health Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100019234","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>After states initiated Medicaid redeterminations following the end of the Medicaid continuous coverage provision, millions of people lost Medicaid coverage. To date, there is limited evidence evaluating how people experienced this \u201cunwinding\u201d process. Using a survey of low-income adults in 4 southern states, we assessed awareness of unwinding, experience with state-based outreach, and understanding of coverage changes. Over half of respondents with some Medicaid enrollment experience (57%) reported having heard \u201ca little,\u201d \u201csome,\u201d or \u201ca lot\u201d about unwinding, with media as the most common source of information. Among respondents who reported losing Medicaid coverage, 55% reported that they thought this was because they were no longer eligible. The majority of those who lost Medicaid found out they had been disenrolled after communication from the state, but about one-quarter learned while trying to seek care. Last, nearly 50% of respondents reported losing coverage prior to April 2023, before the unwinding process began. Incomplete awareness of unwinding among people with Medicaid enrollment and confusion about enrollment status and termination timing underscore an imperative for clear communication about Medicaid benefits, particularly considering recent policies extending 12-month continuous coverage to children and postpartum enrollees. Additionally, policymakers may wish to consider new opportunities and strategies to provide enrollment resources at sites of clinical care (including pharmacies) when people unexpectedly learn about coverage loss at the point of service.<\/jats:p>","DOI":"10.1093\/haschl\/qxaf083","type":"journal-article","created":{"date-parts":[[2025,4,16]],"date-time":"2025-04-16T09:45:01Z","timestamp":1744796701000},"source":"Crossref","is-referenced-by-count":3,"title":["Experiences with Medicaid unwinding among low-income adults in 4 southern states"],"prefix":"10.1093","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5582-9260","authenticated-orcid":false,"given":"Adrianna","family":"McIntyre","sequence":"first","affiliation":[{"name":"Health Policy and Management, Harvard T.H. Chan School of Public Health , Boston, MA 02115 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6507-6047","authenticated-orcid":false,"given":"Benjamin D","family":"Sommers","sequence":"additional","affiliation":[{"name":"Health Policy and Management, Harvard T.H. Chan School of Public Health , Boston, MA 02115 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0081-5154","authenticated-orcid":false,"given":"Gabriella","family":"Aboulafia","sequence":"additional","affiliation":[{"name":"Health Policy and Management, Harvard T.H. Chan School of Public Health , Boston, MA 02115 ,","place":["United States"]},{"name":"Harvard University , Cambridge, MA 02138 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8886-7252","authenticated-orcid":false,"given":"E John","family":"Orav","sequence":"additional","affiliation":[{"name":"Health Policy and Management, Harvard T.H. Chan School of Public Health , Boston, MA 02115 ,","place":["United States"]},{"name":"Department of Medicine, Brigham & Women's Hospital, Harvard Medical School , Boston, Massachusetts ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnold M","family":"Epstein","sequence":"additional","affiliation":[{"name":"Health Policy and Management, Harvard T.H. Chan School of Public Health , Boston, MA 02115 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3811-257X","authenticated-orcid":false,"given":"Jose F","family":"Figueroa","sequence":"additional","affiliation":[{"name":"Health Policy and Management, Harvard T.H. Chan School of Public Health , Boston, MA 02115 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,4,16]]},"reference":[{"issue":"4","key":"2025052712383464400_qxaf083-B1","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1002\/pam.22539","article-title":"Pandemic-era changes to Medicaid enrollment and funding: implications for future policy and research","volume":"43","author":"Dague","year":"2024","journal-title":"J Policy Anal Manage"},{"issue":"12","key":"2025052712383464400_qxaf083-B2","doi-asserted-by":"publisher","first-page":"e224732","DOI":"10.1001\/jamahealthforum.2022.4732","article-title":"Duration and continuity of Medicaid enrollment before the COVID-19 pandemic","volume":"3","author":"Ku","year":"2022","journal-title":"JAMA Health Forum"},{"key":"2025052712383464400_qxaf083-B3","author":"Rampell"},{"key":"2025052712383464400_qxaf083-B4","doi-asserted-by":"publisher","DOI":"10.1377\/forefront.20230515.442033","article-title":"Maintaining coverage gains during Medicaid unwinding","author":"Boozang","year":"2023","journal-title":"Health Aff Forefront"},{"issue":"2","key":"2025052712383464400_qxaf083-B5","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1001\/jamaoncol.2023.5725","article-title":"Unwinding of Medicaid continuous enrollment exposes millions to disrupted care\u2014\u201cbe kind, rewind.\u201d","volume":"10","author":"Barnes","year":"2024","journal-title":"JAMA Oncol."},{"key":"2025052712383464400_qxaf083-B6","author":"Kaiser Family Foundation (KFF)"},{"key":"2025052712383464400_qxaf083-B7","author":"Serafi"},{"key":"2025052712383464400_qxaf083-B8","author":"Corallo"},{"key":"2025052712383464400_qxaf083-B9","author":"Haley"},{"key":"2025052712383464400_qxaf083-B10","author":"Lopes"},{"key":"2025052712383464400_qxaf083-B11","author":"Hest"},{"issue":"5","key":"2025052712383464400_qxaf083-B12","doi-asserted-by":"publisher","first-page":"725","DOI":"10.1377\/hlthaff.2023.01069","article-title":"Unwinding and the Medicaid undercount: millions enrolled in Medicaid during the pandemic thought they were uninsured","volume":"43","author":"Ding","year":"2024","journal-title":"Health Aff"},{"issue":"4","key":"2025052712383464400_qxaf083-B13","doi-asserted-by":"publisher","first-page":"e240430","DOI":"10.1001\/jamahealthforum.2024.0430","article-title":"Survey-reported coverage in 2019-2022 and implications for unwinding Medicaid continuous eligibility","volume":"5","author":"McIntyre","year":"2024","journal-title":"JAMA Health Forum"},{"key":"2025052712383464400_qxaf083-B14","author":"Brooks"},{"issue":"24","key":"2025052712383464400_qxaf083-B15","doi-asserted-by":"publisher","first-page":"2215","DOI":"10.1056\/NEJMp2311336","article-title":"Preliminary data on \u201cunwinding\u201d continuous Medicaid coverage","volume":"389","author":"McIntyre","year":"2023","journal-title":"N Engl J Med."},{"key":"2025052712383464400_qxaf083-B16","author":"Buettgens"},{"key":"2025052712383464400_qxaf083-B17","author":"Alker"},{"issue":"6","key":"2025052712383464400_qxaf083-B18","doi-asserted-by":"crossref","first-page":"e242193","DOI":"10.1001\/jamahealthforum.2024.2193","article-title":"Coverage and Access Changes During Medicaid Unwinding","volume":"5","author":"McIntyre","journal-title":"JAMA Health Forum"},{"issue":"5","key":"2025052712383464400_qxaf083-B19","doi-asserted-by":"publisher","first-page":"e240839","DOI":"10.1001\/jamahealthforum.2024.0839","article-title":"Loss of Medicaid coverage during the renewal process","volume":"5","author":"Dague","year":"2024","journal-title":"JAMA Health Forum"},{"key":"2025052712383464400_qxaf083-B20","author":"Hogan"},{"key":"2025052712383464400_qxaf083-B21","author":"KFF"},{"issue":"6","key":"2025052712383464400_qxaf083-B22","doi-asserted-by":"publisher","first-page":"753","DOI":"10.1377\/hlthaff.2022.01465","article-title":"Continuous eligibility and coverage policies expanded Children's Medicaid enrollment","volume":"42","author":"Vasan","year":"2023","journal-title":"Health Aff."},{"key":"2025052712383464400_qxaf083-B23","author":"U.S. Government Accountability Office"},{"key":"2025052712383464400_qxaf083-B24","author":"Arkansas Department of Human Services"},{"key":"2025052712383464400_qxaf083-B25","author":"KFF"},{"key":"2025052712383464400_qxaf083-B26","author":"James"},{"key":"2025052712383464400_qxaf083-B27","author":"Drake"},{"key":"2025052712383464400_qxaf083-B28"},{"key":"2025052712383464400_qxaf083-B29","author":"Centers for Medicare and Medicaid Services (CMS), Department of Health and Human Services (HHS)"},{"key":"2025052712383464400_qxaf083-B30","author":"Brooks"},{"key":"2025052712383464400_qxaf083-B31","author":"Kirzinger"},{"issue":"10","key":"2025052712383464400_qxaf083-B32","doi-asserted-by":"publisher","first-page":"1816","DOI":"10.1377\/hlthaff.2016.0455","article-title":"Insurance churning rates for low-income adults under health reform: lower than expected but still harmful for many","volume":"35","author":"Sommers","year":"2016","journal-title":"Health Aff."},{"key":"2025052712383464400_qxaf083-B33","volume-title":"Phase 3.8 Household Pulse Survey","author":"US Census Bureau","year":"2023"},{"key":"2025052712383464400_qxaf083-B34","volume-title":"Nonresponse bias report for the 2020 Household Pulse Survey","author":"Peterson","year":"2021"},{"key":"2025052712383464400_qxaf083-B35"},{"key":"2025052712383464400_qxaf083-B36","author":"Roberts"},{"key":"2025052712383464400_qxaf083-B37","author":"Messerly"},{"key":"2025052712383464400_qxaf083-B38","author":"Wikle"},{"issue":"8)","key":"2025052712383464400_qxaf083-B39","doi-asserted-by":"publisher","first-page":"987","DOI":"10.1001\/jamainternmed.2024.1503","article-title":"Racial and ethnic disparities in Medicaid disenrollment after the end of the COVID-19 public health emergency","volume":"184","author":"Rumalla","year":"2024","journal-title":"JAMA Intern Med"}],"container-title":["Health Affairs Scholar"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/advance-article-pdf\/doi\/10.1093\/haschl\/qxaf083\/62936912\/qxaf083.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article-pdf\/3\/5\/qxaf083\/62936912\/qxaf083.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article-pdf\/3\/5\/qxaf083\/62936912\/qxaf083.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T16:38:37Z","timestamp":1748363917000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article\/doi\/10.1093\/haschl\/qxaf083\/8114278"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,16]]},"references-count":39,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,4,30]]}},"URL":"https:\/\/doi.org\/10.1093\/haschl\/qxaf083","relation":{},"ISSN":["2976-5390"],"issn-type":[{"value":"2976-5390","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,5]]},"published":{"date-parts":[[2025,4,16]]},"article-number":"qxaf083"}}