Disparities in Children’s Coverage Loss During the Medicaid Unwinding by Race, Ethnicity, and Income: United States, 2021–2023

Objectives. To estimate changes in children’s public coverage continuity during the April 2023 Medicaid unwinding overall and by race, ethnicity, and income.

Methods. We used 2021 to 2023 US Medical Expenditure Panel Survey data and linear probability models to estimate changes in continuous public coverage and transitions to uninsurance or private or alternative coverage, overall and by race and ethnicity and federal poverty level.

Results. The unwinding was associated with a 5.1 percentage point decrease in continuous public coverage, with similar increases in transitions to uninsurance (2.6 percentage points) and private or alternative coverage (2.5 percentage points). Coverage continuity decreased among non-Hispanic Black, Hispanic, and non-Hispanic White children, with no significant differences by race or ethnicity. Children with family incomes of 200% to 299% of the federal poverty level had the largest increases in transitions to private or alternative coverage.

Conclusions. Improvements in coverage equity during the continuous coverage requirement may not have been sustained during the unwinding. (Am J Public Health. Published online ahead of print October 22, 2026:e1–e10. https://doi.org/10.2105/AJPH.2026.308794)