- About 149,000 Michiganders have lost Medicaid coverage in a 16-month period
- No one’s sure why, but they have theories
- It’s a particular concern now, as Michigan and other states prepare to enforce federal requirements that could squeeze more people from coverage
As states prepare to tighten access around Medicaid benefits, Michigan is facing the possibility of a big rise in people without health insurance.
That includes more than 149,000 people who have already vanished from its Medicaid program in the last 16 months for reasons that elude many experts.
They do not appear to have gained coverage through employers — at least not all of them, according to the Michigan Association of Health Plans, which tracks insurance enrollment data.
Nor do those 149,000 — representing a drop of more than 5% in total enrollment — appear to have migrated en masse to the federal marketplace where consumers buy insurance directly.
It’s a particular concern now for advocates for Michigan’s low-income and disabled residents, who worry that many of those 149,000 residents are now uninsured.
“We just don’t know what is driving that loss in enrollment,” said Dominick Pallone, executive director of the insurance association.
There are several theories for the decline — from confusion about ever-changing policies to the immigration crackdown to cuts in critical staff. Some even cite a better economy.
But it comes as even more Michiganders are likely to lose coverage through Medicaid starting next year.
Michigan and other states are gearing up for new federal requirements that will force beneficiaries next year to prove they are working, looking for work, engaged in the community, going to school or in a training program.
The Trump administration is still releasing guidance on those requirements — the latest arrived this week. In Michigan, the Whitmer administration has estimated that up to 200,000 residents will lose coverage under the new requirements, including some who are eligible, but fail to submit all their necessary documentation.
“We’re looking down the end of the barrel here,” said Jeremy Lapedis, executive director of the Washtenaw Health Project, an Ann Arbor-based nonprofit that works with the Washtenaw County health department to help residents find affordable coverage.
Left without coverage, those Michiganders will seek treatment only when it’s most serious and most expensive, Lapedis said.
It’s a problem that leads to medical debt for the individual and drives up health care costs for everyone.
“Those costs (for uninsured people) have to shift somewhere — whether it’s on the hospitals or places like ours,” said Jessica Kowalski, deputy director of clinical operations at the ACCESS Community Health and Research Center, a Dearborn-based community service organization that provides medical care.
The drop in Medicaid enrollment over the past year or so — even before new federal requirements, “may be a precursor to what we’re going to see in the future, which is just a huge stress to the entire health care system,” said Jeremy Lapedis, executive director of the Washtenaw Health Project, an Ann Arbor-based nonprofit that works with the Washtenaw County health department to help residents find affordable coverage.
In fact, the numbers of Michiganders covered by Medicaid significantly dropped the latter half of last year — more so than the US in general, according to KFF, a San Francisco-based nonprofit focused on health research.
At ACCESS, staff see the change firsthand, said Kowalski.
“People are coming in and we check their insurance,” Kowalski said, “and we tell them, ‘Your insurance is inactive.’ They’re shocked. They’re like, ‘What do you mean?’”
State officials appear baffled at the loss, too.
The Michigan Department of Health and Human Services is “monitoring this trend closely,” department spokesperson Laina Stebbins said in an email to Bridge.
“Identifying and understanding the factors driving this decline is an important area of focus for the department,” she wrote.
Post-COVID rightsizing or a concern?
There’s an argument that Michigan’s Medicaid program — one that cost $25 billion in 2024, according to the most recent numbers — is simply being made more efficient and slicing out what critics, including President Trump, say is waste and abuse.
Whatever the cause for the declining enrollment, it means less taxpayer money being spent on Medicaid in the short-term.
Cost savings weren’t immediately available on Wednesday but likely tally tens of millions of dollars a year.
By one 2022 estimate, an additional 775,000 people getting Michigan Medicaid during the pandemic cost Michigan taxpayers $50 million a month.
“It’s always easy to take the negative side of this, but I think the good part is that we’ve been able to graduate some people off Medicaid,” state Rep. Curt VanderWall, R-Ludington, said. “They’ve actually found full-time employment … and (become) independent.”
State Rep. Phil Green, R-Watertown Township, agreed. He’s vice chair on the House Appropriations Subcommittee on Medicaid and Behavioral Health.
There’s a “plethora of reasons” — good and bad — behind the disenrollments, he said.
“I think without doing … exit interviews, we’re just sort of surmising,” the reasons behind the enrollment drop, he said.
And long term, the shrinking enrollment is less stark: Enrollment last month remained slightly above enrollment just prior to the pandemic: There were about 46,000 more people in Medicaid in April then in March 2020, the month Michigan confirmed its first COVID case.
‘Churn’
Certainly, monthly enrollment in Medicaid fluctuates. It exploded, in fact, during COVID.
As the pandemic gripped the US in 2020, Michigan and other states suspended annual eligibility reviews that caused a “churn” of people in and out of Medicaid each month.
With few exceptions, federal law prevented anyone from being disenrolled from Medicaid during the pandemic. The goal was to help people remain insured during the global health scare and economic upheaval.
By June 2023, that meant that nearly 3.3 million Michiganders — nearly
1 in 3 — was covered either by traditional Medicaid, which generally covers the lowest-income or disabled residents, and Healthy Michigan, which covers those whose family income is up to 138% of the federal poverty level and are relatively healthy.
In June that year, annual reviews restarted under the direction of the Biden administration. The year-long process, known as “unwinding,” whittled Michigan’s Medicaid back to fewer than 2.7 million by the end of 2024, according to state data.
That’s when experts expected enrollment to stabilize.
But since then, enrollment has continued to tumble — to just over 2.5 million by the end of April 2026, according to state data.
“You would have expected (the decline) to level off at some point,” said Lapedis at the Washtenaw Health Project. “It hasn’t, and we don’t know why.”
Moreover, more than 175,000 Medicaid beneficiaries are now enrolled in Plan First, a Medicaid plan launched in 2023 that provides narrow coverage limited to sexual health only.
While Plan First beneficiaries would have no coverage at all otherwise, their numbers further inflates the total size of Michigan’s Medicaid enrollees, said Pallone at the insurance industry group.
Anxiety, aging and other theories
Advocates have offered several theories for the drop in Medicaid enrollment. Among them: anxiety.
The debate last year and ultimate passage of the “Big, Beautiful Bill,” made it clear that big cuts and stricter rules in Medicaid are ahead.
Confused, some Michiganders “might just not be re-enrolling or applying to begin with,” said Amber Bellazaire, a senior policy analyst for the Michigan League for Public Policy, a Lansing-based nonprofit organization that advocates for low-income Michiganders.
Additionally, a high-profile, nationwide crackdown on immigration likely forced down enrollment, too, said Jennifer Tolbert, deputy director of the Program on Medicaid and the Uninsured at KFF, a nonprofit health policy research, polling, and news organization.
Undocumented immigrants do not have access to full Medicaid benefits in Michigan; however, they may get emergency care, according to state eligibility criteria.
“That population is on edge right now for good reason,” agreed Pallone, at the insurance group. “They could be a total lawful citizen, properly enrolled in Medicaid … and worry that they’re going to get swept up in some ICE raid at (a state government) office if they go and show up to reapply.”
Another theory: Michigan is aging faster than other states. About 380 Michiganders each day turn 65, the age at which they age into Medicare.
And it may be, as VanderWall suggested, that some Michiganders have taken higher-paying jobs after the pandemic, and they’re accessing insurance now through their employers or the individual marketplace, www.healthcare.gov, Pallone said.
Still, any growth in Medicare, employer-sponsored or marketplace plans falls far short of 149,000 people, he added.
‘Slashed’
Pallone also believes short staffing at local state offices has disrupted coverage for some beneficiaries who need in-person help.
“That’s a leading theory right now,” he said.
Finally, the Trump administration last year slashed nearly all funding for navigators, the on-the-ground staff that help Americans sort through options and enroll in coverage, said Kowalski at ACCESS.
For its part, Michigan’s funding dropped from $2.8 million to $280,000, forcing ACCESS to cancel its 22 contracts with navigators throughout the state and to lay off two of its own staff, Kowalski said.
All of this leaves the question: Are the 149,000 people now without coverage?
“We’re a bit at a loss,” Pallone said.
