Medicaid enrollment has risen to unprecedented levels since the start of the COVID-19 pandemic. In an earlier analysis, we showed that most of this new Medicaid enrollment was from the continuous coverage requirement of the Families First Coronavirus Response Act. One of the most urgent issues for policymakers this year is what will happen to the health coverage of these millions of new enrollees after the HHS public health emergency (PHE) ends. The PHE will probably be extended through the first half of 2022, and further extension is possible.

In this brief, we project Medicaid enrollment for the population under age 65 and federal and state Medicaid spending for 2022 and 2023, assuming the PHE is extended through the first, second, or third quarters of 2022. We find that the longer the PHE lasts, the greater the potential number of people losing Medicaid coverage over the 14 months after the PHE ends: 12.9 million if it expires after the first quarter of 2022, 14.4 million if it expires after the second quarter, and 15.8 million if it expires after the third quarter.