Understanding Cross-State Variations in Medicaid Enrollment During and After the COVID-19 Pandemic

The implementation and unwinding of the FFCRA's continuous coverage requirement generated historically large changes in Medicaid enrollment during the COVID-19 pandemic. Using a combination of descriptive and causal analyses, we examine the substantial cross-state differences in these changes, which remain little understood. We find that policies designed to ease unwinding frictions, as well as federal fiscal assistance to states, have little predictive power, suggesting limited roles for administrative design or liquidity constraints. Political preferences have modest predictive power during the unwinding period. Pandemic-era Medicaid expansions and more generous baseline eligibility thresholds are strongly associated with larger net enrollment gains.