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Almost 1.8 million Americans have been disenrolled from Medicaid health coverage in Texas in the last two years, according to data by KFF, a nonprofit health policy research and news organization.

These Americans have lost their health insurance as part of the unwinding process happening nationwide after Medicaid coverage was expanded following the COVID pandemic.

A spokesperson for the Texas Health and Human Services Commission (HHSC) told Newsweek it is “committed to ensuring that those qualified for benefits receive them,” and worked closely with the Centers for Medicare & Medicaid Services (CMS) “throughout the public health emergency and the Medicaid unwind process.”

“Federal guidance required HHSC to redetermine eligibility for 6 million Medicaid clients over the course of 12 months,” they added.

“Redetermining eligibility within federal requirements was a massive undertaking. Throughout the unwind, HHSC met with our federal partners on a regular basis to ensure that we followed federal guidance, and we will continue to collaborate with CMS to provide eligible Texans with benefits.”

Why It Matters

The unwinding process has resulted in significant drops in Medicaid enrollment across the U.S. in recent years. While some of those disenrolled from Medicaid may still have had access to other forms of health insurance through their employment, those left without insurance could be in a vulnerable position. Higher rates of uninsured populations in states have been associated with negative impacts on health outcomes and medical costs.

File photo: doctors treat a child in a hospital. File photo: doctors treat a child in a hospital. Gerald Herbert/AP

What To Know

During the pandemic, some states expanded Medicaid coverage under the Affordable Care Act (ACA) while some Americans may have being encouraged to enroll for health coverage given the spread of the virus, causing nationwide enrollment levels to increase.

Federal rules then meant states had to keep most Medicaid enrollees on the program even if their eligibility status changed, a requirement which expired in March 2023, allowing states to resume removing individuals from the program.

Medicaid enrollment has since steadily declined, driven by both eligibility losses and procedural disenrollments.

In Texas, there were 5,922,450 covered by Medicaid in March 2023, but by March 2025, that number was 4,164,694, KFF data shows.

This marks a change of almost 1.8 million, a rate of decline faster than in Florida, California and New York.

The number of people with Medicaid coverage is now just lower than February 2020 levels, a difference of 1 percent.

Reasons for Texas’ steeper drop in Medicaid enrollment could be because of the fact it, combined with Florida, New York and California, made up a significant proportion of Medicaid enrollment before the unwinding, Timothy McBride, a professor of public health at Washington University in St. Louis, told Newsweek.

All four states together accounted for 36 percent of Medicaid enrollment and subsequently accounted for 31 percent of the drop in the unwinding period between 2020 and 2025, he added.

This is in part because the states have large populations, but also because they have some of lowest percentages of health insurance coverage by employers or private plans, McBride said.

This is due to “higher poverty rates, especially in Florida and Texas, fewer good jobs that offer health insurance, and a higher percentage of nonwhite persons, especially in Florida, Texas, and California,” he said.

“If they do not have private coverage they seek Medicaid,” he added.

For those that were able to gain health insurance through private coverage once being rolled off Medicaid, there is little concern.

However, those that may remain uninsured as a result of the unwinding process “I am worried about,” McBride said.

“The negative outcomes could be delays in seeking needed medical care leading to worse outcomes, lack of prevention, which is especially problematic if they have chronic conditions, bad mental health and financial outcomes, and higher medical debt since they have to pay for more out of pocket,” he added.

What People Are Saying

Timothy D. McBride, professor of public health at Washington University in St. Louis, told Newsweek: “Part of the drop is people who maintained Medicaid coverage on paper because they got it at some point during the pandemic but remained there through the PHE. Yet some may have moved along and obtained other coverage, so really were not needing the Medicaid anyway. The group we are concerned about is those who have become uninsured or who lost the coverage for procedural reasons. It appears from some work that maybe 30 percent or so of those who lost coverage may be uninsured. And a lot of people—around that number lost coverage for procedural reasons, many of them children.”

Laura Dague, a professor of health policy at Texas A&M University, told Newsweek: “How impactful the decreases in enrollment will be in terms of individual health depend on how aware people were of their ongoing coverage and how often they used it, and there is not much empirical evidence on this topic at the moment. A much bigger issue for Texas in my opinion will be the upcoming projected decreases in Marketplace enrollment due to decreasing subsidies; Texas has had major growth in that market in the last few years as subsidies increased.”

What Happens Next

As the unwinding continues, more reductions in enrollment are expected in the state, and across the country. With millions already having lost health coverage, concerns remain about access to care for low-income individuals and families.