Health Aff (Millwood). 2026 Aug;45(8):934-942. doi: 10.1377/hlthaff.2025.01585.
ABSTRACT
During the unwinding of the continuous coverage requirements related to the COVID-19 public health emergency in 2023, as an unprecedented volume of consumers were transitioning out of Medicaid, California launched a facilitated enrollment program for people who lost Medicaid and were eligible for subsidized Marketplace coverage. We conducted a survey in 2023-24 to assess coverage outcomes among Californians who lost Medicaid coverage, were assigned to a default plan, and had thirty days to opt in to coverage under the program. Although national surveys indicate high rates of uninsurance after loss of Medicaid, we found that 85 percent of those who were eligible for an Affordable Care Act Marketplace subsidy had some form of health insurance. Among those without other available coverage, nearly two-thirds opted in to a Marketplace plan. People with a high school education or less were least likely to enroll in Covered California, as were those who rated their health status as poor. Even after we accounted for premium amounts, income, education, health status, and language preference, take-up was higher among Asian/Asian American (84 percent) and White (79 percent) people than among Hispanic/Latino (53 percent) and Black/African American (54 percent) people. Our findings indicate that facilitated enrollment interventions should be strengthened to overcome administrative and other burdens that persist among subpopulations.
PMID:42546240 | DOI:10.1377/hlthaff.2025.01585
