Medicaid, the government-funded U.S. health insurer for people with low incomes, grew by about 25% between February 2020 and May 2022 as policies adopted at the outset of the COVID-19 pandemic expanded the program’s reach.

All told, the number of people enrolled in Medicaid and the Children’s Health Insurance Program, or CHIP, which serves kids in families with low to moderate incomes, increased from 71 million to 89 million. That’s roughly 27% of all Americans.

The pandemic-related increase in Medicaid enrollment was slightly larger than the 24.7% increase seen after the Affordable Care Act (ACA) expanded Medicaid for adults, starting in 2014.

But unlike Medicaid expansion under the ACA, these pandemic policies are temporary. They will end once the federal government’s COVID-19 public health emergency expires. Some experts predict Medicaid enrollment could fall by as many as 15 million people when this happens, disrupting health care for many Americans.

In a new article we published in the Journal of the American Medical Association on Sept. 20, 2022, we examine how Medicaid serves Americans, analyze the program’s importance for health equity, and assess how Medicaid grew and changed during the COVID-19 pandemic.

As health policy researchers, we believe that Medicaid’s growth since 2020 highlights the program’s importance during economic and public health crises. It also underscores how painful the unwinding of these pandemic policies is likely to be to those who may end up uninsured.

In March 2020, Congress passed the first of several large spending packages, called the Families First Coronavirus Response Act. To help states shoulder increased Medicaid costs associated with the pandemic, that measure increased the share of Medicaid spending the federal government pays for by 6.2 percentage points in all states.

This aid has made a big difference for states, which split the costs of Medicaid with the federal government. Before the pandemic, the federal government was paying about 65% of Medicaid’s costs overall, with the precise share varying based on a state’s average income. States picked up the other 35% of Medicaid costs. These costs accounted for more than one-fourth of state budgets before the pandemic.

The extra federal money for Medicaid came with an important requirement: states accepting funds could not remove anyone from Medicaid who was enrolled as of March 2020 or gained Medicaid afterwards – as long as the official public health emergency, first declared on Jan. 31, 2020, remained in effect. These policies also applied to CHIP.

All 50 states and the District of Columbia accepted the higher federal payments in exchange for keeping Medicaid enrollment stable during the pandemic.

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