Roughly 15 million people could fall off Medicaid rolls in the next year as states begin to redetermine eligibility for the first time since the COVID-19 pandemic began, as a provision under the COVID-19 public health emergency that allowed individuals to stay enrolled unwinds.

About 18% of people enrolled in Medicaid, or about 15 million people, are projected to lose their coverage when states begin to disenroll people starting April 1 who are no longer eligible due to exceeding the income levels or another qualification for the program, according to a Kaiser Family Foundation survey of state officials.

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"As states begin to 'unwind' the continuous enrollment provision, many people will likely be found to be no longer eligible for Medicaid. Others could face administrative barriers and lose coverage despite remaining eligible," the report concluded.

States were required to offer continuous enrollment for Medicaid, a federal and state program that helps with healthcare costs for some people with limited income and resources, in order to receive additional federal funding during the emergency declaration. It has allowed most individuals to remain enrolled and not have to reapply for coverage.

Prior to continuous enrollment, people would typically experience lapses in their coverage when they temporarily had an income above the amount to qualify for coverage, requiring them to reenroll.

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Enrollment in Medicaid has soared during the pandemic due to continuous enrollment and states passing bills to expand access to the health program. As part of last year's omnibus bill, Congress reached a deal to allow states to begin removing ineligible people next month. The Biden administration has since announced it plans to let the COVID-19 public health emergency expire in May.

It comes as many states face staffing challenges that could affect their ability to review renewals for Medicaid. More than half of the 49 states that responded to the Kaiser Family Foundation survey said they have staff vacancy rates over 10% for "front-line eligibility workers," noting that they plan to approve overtime and hire new staff and temporary workers to address the shortages.