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Study: Auto-renewals in Medicaid prevented coverage losses

A new study finds an intervention to facilitate automated Medicaid renewals successful during the unwinding process, signaling a potential solution under Trump's new eligibility rules.

Jacqueline LaPointe
By
Published: 06 Nov 2025

A government-led effort to automate Medicaid renewals after the unwinding of continuous enrollment post-pandemic was effective at increasing overall renewals and reducing procedural denials, according to a new study.

The study published in the November 2025 issue of Health Affairs examined Medicaid enrollment data between March 2023 and March 2024. At that time, CMS mandated that states report monthly data as they unwound the pandemic-era policy that prevented Medicaid disenrollment -- an issue that affected more than 90 million beneficiaries.

Seeking to limit the burden of manual renewals, CMS partners with the U.S. Digital Service, a federal agency responsible for providing support to ensure the effective delivery of government benefits and services, to implement an intervention aimed at increasing ex parte renewals. Ex parte renewals leverage existing administrative data, including wages from state labor agencies and income data from other benefit programs, to automate Medicaid renewals.

The intervention showed four states -- California, New York, South Carolina and Wisconsin -- how to process more ex parte cases by identifying sources of administrative data and digital tools to process renewals automatically. And it succeeded, according to the Health Affairs study.

The study found that, under the intervention, Medicaid ex parte renewals increased by 21.6 percentage points, with overall Medicaid renewals also growing by 7.7 percentage points. Meanwhile, procedural denials for missing paperwork and other administrative errors decreased by 8.3 percentage points.

"The speed and size of the intervention's impact offer important lessons that go beyond the 'unwinding,'" researchers stated in the study.

The challenges of ex parte Medicaid renewals

The Health Affairs study demonstrated the value of ex parte Medicaid renewals -- they can significantly reduce adverse outcomes from procedural denials, which have always plagued the Medicaid program.

Individuals eligible for Medicaid oftentimes struggle to renew coverage because they did not receive the renewal form, were confused about how to fill it out or struggled to identify the information and documentation required for renewal.

These problems were especially prevalent during Medicaid unwinding in late 2023, when one-third of beneficiaries lost coverage. Of those losing Medicaid, about 70% involved procedural denials due to incomplete paperwork, according to a report from Georgetown University's McCourt School of Public Policy. Meanwhile, KFF reported that 55% of people who retained Medicaid coverage were renewed through the ex parte process, as of October 2023.

However, states face many challenges with ex parte renewals. The Medicaid and CHIP Payment and Access Commission previously found that states encounter data obstacles, including accessing relevant data sources. States also must contend with competing priorities and resource restraints, which have delayed IT system upgrades that can facilitate data sharing.

Many states have increased efforts to conduct ex parte renewals, particularly under federal direction; however, as of September 2023, the government found that 30 states had been incorrectly doing so, according to KFF.

Ex parte renewals after the unwinding

The spotlight is on Medicaid enrollment after President Donald J. Trump signed the One Big Beautiful Bill Act (OBBBA) into law over the summer. Under the OBBBA, states must implement new Medicaid renewal processes and work requirements for eligibility.

Specifically, the law will increase application and other paperwork requirements for applying and maintaining Medicaid coverage. By January 2027, states will also have to conduct eligibility checks for individuals covered under the Medicaid expansion every six months, up from the required annual review.

Research from the Urban Institute has shown that these changes will disproportionately impact young adults who tend to struggle more with completing paperwork and move more frequently than older adults, creating challenges with receiving renewal notifications.

States also will not have the backing of the U.S. Digital Service, according to the study in Health Affairs. The agency has since been replaced by the U.S. Department of Government Efficiency, or DOGE, Service, which has prioritized fraud reduction.

Still, policymakers may need to come up with an idea to support states under new renewal requirements.

"The findings ultimately demonstrate that changes in administrative burdens are policy choices," the study concluded. "Through policy implementation, states can influence how much the new Medicaid requirements lead to eligible beneficiaries losing coverage for administrative reasons."

Jacqueline LaPointe is a graduate of Brandeis University and King's College London. She has been writing about healthcare finance and revenue cycle management since 2016.

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