Fact check: Can individuals who lose Medicaid qualify for other health insurance options?

1. What claim-makers say about alternatives — a tight but fractured picture

The body of analyses asserts a central claim: losing Medicaid does not invariably leave people uninsured because many can qualify for other insurance, but the transition is uneven and policy-dependent. Multiple pieces emphasize that CMS urged states to link former enrollees to marketplace plans, employer coverage, or Medicare when eligible, and that some state tools—continuous‑eligibility periods, Section 1115 waivers, and ex‑parte reviews—can reduce abrupt loss and smooth transitions ^{[1] [3]}. These sources present a mixed narrative that combines practical pathways to replacement coverage with repeated warnings that those pathways are imperfect and depend on state execution ^{[1] [3]}.

2. Evidence that many displaced enrollees find new coverage — aggregate studies

Several analyses report that aggregate uninsured rates did not spike materially after Medicaid redeterminations, implying substantial shifting into other coverage sources such as marketplace plans or employer insurance. A Federal Reserve working paper found a 6–12% drop in Medicaid enrollment but no statistically significant rise in the overall uninsured rate for adults under 65, interpreting the result as evidence that many displaced enrollees moved to alternate plans ^[4]. Similarly, longitudinal work shows many people re‑enroll in Medicaid within a year or obtain other coverage after disenrollment, underscoring how multiple mechanisms operate to preserve coverage for large shares of those affected ^{[3] [5]}.

3. But a large and visible minority falls through — the human cost

The literature repeatedly highlights that a meaningful share of former Medicaid beneficiaries remain uninsured or experience harmful gaps, with serious consequences for vulnerable groups. Older studies documented that nearly half of disenrolled adults stayed uninsured six months after loss, with only a third securing other insurance and significant demographic disparities in outcomes ^[5]. Targeted case studies show worse clinical outcomes, including increased mortality among specific populations transitioned from Medicaid to marketplace plans, indicating that substitution does not always sustain access to needed care ^[2]. Those findings underscore the uneven human toll behind aggregate stability.

4. Marketplace coverage is an imperfect substitute — evidence from state experiences

Analyses comparing Medicaid and marketplace substitution find substantial frictions: enrollment take‑up into marketplace plans can be low and outcomes worse for some groups. Colorado research noted very low marketplace enrollment among those losing Medicaid in past years, showing marketplace coverage is not a direct one‑to‑one replacement for many low‑income adults ^[6]. The Hawaii COFA migrant case further shows that administrative transitions into marketplace plans can worsen health outcomes for vulnerable populations, signaling that eligibility alone does not ensure equitable access once those individuals must navigate premiums, networks, and cost sharing ^[2].

5. Dual eligibles and the Medicare backstop — a partial safety valve

For people who qualify for Medicare, losing Medicaid often removes supplemental protections but not core Medicare coverage; Medicare remains a critical fallback for seniors and those with disabilities. Studies of dual‑eligible beneficiaries show that Medicaid loss primarily affects supplemental benefits—dental, long‑term care, and Medicare cost‑sharing—while Medicare coverage persists. Integrated dual‑eligible programs and special needs plans reduce risk of losing Medicaid and help maintain integrated coverage, suggesting program design can mitigate negative effects of disenrollment ^[3].

6. State policy choices and CMS guidance determine outcomes more than individual luck

The analyses converge on the point that state administrative choices and federal guidance shape whether eligibility loss translates into lasting uninsured spells. CMS encouraged states to connect people to other programs, and evidence shows policies like 12‑month continuous eligibility, Section 1115 waivers, and proactive ex‑parte reviews reduce churn and preserve coverage continuity. Where states actively link disenrolled individuals to marketplaces or streamline redetermination, the transition is smoother; where states do not, disenrollment produces larger uninsured pockets and worse health outcomes ^{[1] [3]}.

7. Numbers matter: churn is common and transitions are messy

Empirical estimates emphasize volatility: pre‑pandemic churn studies reported that 20% of adults left Medicaid within six months and 55% within two years, with only a portion obtaining other coverage quickly. Pandemic‑era continuous enrollment sharply reduced churn, and ending that protection produced measurable Medicaid declines without a clear net rise in uninsured adults but with subgroup risks. These magnitudes mean policymakers face tradeoffs between administrative rigor and coverage stability; the available evidence paints a nuanced picture where many transition successfully, yet substantial at‑risk groups continue to lose access or suffer worse outcomes ^{[5] [4] [1]}.

8. Bottom line — substitution possible but not guaranteed; policy determines who wins and who loses

The collective evidence supports a conditional conclusion: individuals who lose Medicaid can often qualify for other health‑insurance options, but success depends heavily on state actions, population vulnerability, and plan suitability. Marketplace and employer plans provide pathways for many, Medicare covers seniors and disabled, and integrated programs help dual‑eligibles; nonetheless, significant fractions remain uninsured or experience adverse health outcomes when transitions are poorly managed. Policymakers aiming to minimize harm must combine administrative safeguards, active linkage strategies, and supports tailored to vulnerable populations ^{[1] [2] [3]}.