Nearly 1.8 million Texans have lost Medicaid coverage—here’s what that means for health care access
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Nearly 1.8 million people in Texas have lost their Medicaid health coverage over the past two years, marking one of the steepest enrollment drops in the country.
This wave of disenrollments is part of a broader, federally mandated process known as the “Medicaid unwinding,” which resumed after pandemic protections expired.
During the public health emergency, states were required to keep most enrollees continuously covered, even if their eligibility changed.
But now, states like Texas are once again reviewing everyone’s eligibility—and the consequences have been far-reaching.
With more residents potentially losing their safety net, many families are left wondering what happens next.
The rollback of pandemic protections
During COVID-19, emergency federal rules paused the usual Medicaid eligibility checks to prevent people from losing health coverage during a crisis.
These continuous coverage requirements ended in March 2023, prompting states to resume their typical redetermination processes.
In Texas, the Health and Human Services Commission (HHSC) was required to evaluate eligibility for 6 million Medicaid recipients within just 12 months.
A spokesperson for HHSC told Newsweek that the agency worked closely with federal partners throughout the process, saying, “Redetermining eligibility within federal requirements was a massive undertaking.”
They added, “We will continue to collaborate with CMS to provide eligible Texans with benefits.”
Also read: Medicaid data-sharing agreement with ICE raises privacy questions—what to know
Texas sees the largest drop in the country
According to data from nonprofit health policy group KFF, Medicaid enrollment in Texas dropped from nearly 5.9 million people in March 2023 to 4.16 million in March 2025.
That’s a decline of nearly 1.8 million people—more than any other state, and faster than Florida, California, or New York.
Part of the reason is Texas’ large population.
But experts say there are deeper factors at play, including higher poverty rates, fewer jobs offering private insurance, and a greater proportion of nonwhite residents who are statistically less likely to have employer-sponsored coverage.
As public health professor Timothy McBride told Newsweek, “If they do not have private coverage, they seek Medicaid.”
Also read: Taxpayers stand to save $30 billion with Medicaid reform
What happens to people losing coverage?
Some Texans who lost Medicaid have since gained private insurance through jobs or enrolled in ACA Marketplace plans.
But many others haven’t.
McBride estimates that about 30% of those who lost Medicaid are now uninsured—hundreds of thousands of people, including many children.
“The negative outcomes could be delays in seeking needed medical care leading to worse outcomes, lack of prevention, bad mental health and financial outcomes, and higher medical debt,” he said.
The issue is especially concerning for older adults and low-income families managing chronic conditions or mental health care.
Also read: Could changes to Medicaid funding put your local hospital in danger?
Why the steep drop matters
Texas, along with California, Florida, and New York, accounted for 36% of Medicaid enrollment before the unwinding and 31% of the total enrollment decline between 2020 and 2025.
The significant drop in Texas highlights how demographic and economic factors intersect with access to care.
The number of Texans currently covered by Medicaid is now just below February 2020 levels—a decline of about 1%.
While some people never truly relied on Medicaid during the pandemic, others have been left uninsured simply due to missed paperwork or unclear requirements.
Also read: Is your healthcare at risk? Millions could lose coverage if Medicaid cuts become law
Marketplace coverage and future risks
Laura Dague, a health policy professor at Texas A&M University, told Newsweek that Texas saw major growth in Marketplace enrollment during the pandemic, thanks in part to increased subsidies.
But with those subsidies projected to decrease, more people could lose affordable private coverage in the coming years.
“How impactful the decreases in enrollment will be depends on how aware people were of their coverage and how often they used it,” she explained, adding that there's not much hard data yet on this topic.
Also read: The truth about Medicaid cuts and the misinformation spreading online
What you can do now
The unwinding process is still ongoing, meaning more Texans could lose coverage in the months ahead.
If you're enrolled in Medicaid or think you may be eligible, here are steps to take:
More broadly, the decline in Medicaid enrollment affects entire communities.
When fewer people have coverage, local hospitals and clinics take on more unpaid care, raising costs for everyone.
At a time when healthcare access is already fragile for many, the effects of the Medicaid unwind could be long-lasting.
Read next: Is your health care is at risk? Uncover what the shocking Medicaid cuts in the House budget mean for you
Have you or someone you know been affected by these changes? Share your experience with The GrayVine—your story might help others understand their options and advocate for better care.
This wave of disenrollments is part of a broader, federally mandated process known as the “Medicaid unwinding,” which resumed after pandemic protections expired.
During the public health emergency, states were required to keep most enrollees continuously covered, even if their eligibility changed.
But now, states like Texas are once again reviewing everyone’s eligibility—and the consequences have been far-reaching.
With more residents potentially losing their safety net, many families are left wondering what happens next.
Many Texans are facing uncertainty about their health coverage as Medicaid eligibility reviews continue across the state. Image Source: Pexels / Pixabay.
The rollback of pandemic protections
During COVID-19, emergency federal rules paused the usual Medicaid eligibility checks to prevent people from losing health coverage during a crisis.
These continuous coverage requirements ended in March 2023, prompting states to resume their typical redetermination processes.
In Texas, the Health and Human Services Commission (HHSC) was required to evaluate eligibility for 6 million Medicaid recipients within just 12 months.
A spokesperson for HHSC told Newsweek that the agency worked closely with federal partners throughout the process, saying, “Redetermining eligibility within federal requirements was a massive undertaking.”
They added, “We will continue to collaborate with CMS to provide eligible Texans with benefits.”
Also read: Medicaid data-sharing agreement with ICE raises privacy questions—what to know
Texas sees the largest drop in the country
According to data from nonprofit health policy group KFF, Medicaid enrollment in Texas dropped from nearly 5.9 million people in March 2023 to 4.16 million in March 2025.
That’s a decline of nearly 1.8 million people—more than any other state, and faster than Florida, California, or New York.
Part of the reason is Texas’ large population.
But experts say there are deeper factors at play, including higher poverty rates, fewer jobs offering private insurance, and a greater proportion of nonwhite residents who are statistically less likely to have employer-sponsored coverage.
As public health professor Timothy McBride told Newsweek, “If they do not have private coverage, they seek Medicaid.”
Also read: Taxpayers stand to save $30 billion with Medicaid reform
What happens to people losing coverage?
Some Texans who lost Medicaid have since gained private insurance through jobs or enrolled in ACA Marketplace plans.
But many others haven’t.
McBride estimates that about 30% of those who lost Medicaid are now uninsured—hundreds of thousands of people, including many children.
“The negative outcomes could be delays in seeking needed medical care leading to worse outcomes, lack of prevention, bad mental health and financial outcomes, and higher medical debt,” he said.
The issue is especially concerning for older adults and low-income families managing chronic conditions or mental health care.
Also read: Could changes to Medicaid funding put your local hospital in danger?
Why the steep drop matters
Texas, along with California, Florida, and New York, accounted for 36% of Medicaid enrollment before the unwinding and 31% of the total enrollment decline between 2020 and 2025.
The significant drop in Texas highlights how demographic and economic factors intersect with access to care.
The number of Texans currently covered by Medicaid is now just below February 2020 levels—a decline of about 1%.
While some people never truly relied on Medicaid during the pandemic, others have been left uninsured simply due to missed paperwork or unclear requirements.
Also read: Is your healthcare at risk? Millions could lose coverage if Medicaid cuts become law
Marketplace coverage and future risks
Laura Dague, a health policy professor at Texas A&M University, told Newsweek that Texas saw major growth in Marketplace enrollment during the pandemic, thanks in part to increased subsidies.
But with those subsidies projected to decrease, more people could lose affordable private coverage in the coming years.
“How impactful the decreases in enrollment will be depends on how aware people were of their coverage and how often they used it,” she explained, adding that there's not much hard data yet on this topic.
Also read: The truth about Medicaid cuts and the misinformation spreading online
What you can do now
The unwinding process is still ongoing, meaning more Texans could lose coverage in the months ahead.
If you're enrolled in Medicaid or think you may be eligible, here are steps to take:
- Check your mail and email for renewal notices from HHSC and respond right away.
- Update your contact information with the state so you don’t miss important updates.
- Explore alternative coverage options like the ACA Marketplace, Medicare, or local programs if you lose Medicaid.
- Reach out to community health centers, navigators, or local nonprofits for free help understanding your options.
More broadly, the decline in Medicaid enrollment affects entire communities.
When fewer people have coverage, local hospitals and clinics take on more unpaid care, raising costs for everyone.
At a time when healthcare access is already fragile for many, the effects of the Medicaid unwind could be long-lasting.
Read next: Is your health care is at risk? Uncover what the shocking Medicaid cuts in the House budget mean for you
Have you or someone you know been affected by these changes? Share your experience with The GrayVine—your story might help others understand their options and advocate for better care.
