Medicaid Churn Toolkit

02/16/2024 | By: Jamila McLean, Healthcare Policy Manager

Understanding Medicaid Churn

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As the nation’s largest insurance provider, Medicaid currently serves over 80 million individuals. Increasing coverage continuity among Medicaid beneficiaries is crucial to improving health equity and economic mobility among low-income populations. Medicaid churn — the cycling of individuals on and off Medicaid coverage — is a common and persistent problem within the healthcare delivery system, increasing  healthcare and administrative costs and resulting in poor outcomes due to disruptions in care. Research has shown that approximately  25 percent of Medicaid beneficiaries experience at least one coverage change within a year.

In March of 2020, federal response to the COVID-19 pandemic temporarily eliminated Medicaid churn as the Families First Coronavirus Response Act (FFCRA) prevented states from disenrolling Medicaid beneficiaries. However, after the passage of the Consolidated Appropriations Act of 2023 (CAA), the protection afforded by the FFCRA ended on March 31, 2023, putting a significant number of Medicaid beneficiaries at risk for disenrollment. Beginning April 2023, states began the process of unwinding the Medicaid continuous coverage requirement and resuming regular Medicaid renewal processes. States have adopted numerous policy and practice flexibilities to mitigate the likelihood of procedural terminations – losing Medicaid for a reason other than being ineligible – and high rates of churn.

Investments in efforts that reduce Medicaid churn can result in more efficient Medicaid agencies and administrative cost savings, reducing staff workload and allowing staff and resources to be dedicated to other priorities. With support from the Robert Wood Johnson Foundation, Benefits Data Trust (BDT) developed this “Medicaid Churn Toolkit” to guide Medicaid agencies and their partners in the design and implementation of efforts to reduce churn.

This Toolkit was originally published in September 2021 and updated in February 2024.

The “Medicaid Churn Toolkit” provides step-by-step guidance and templates to facilitate goal setting, collaborative planning and execution and will help users:

Understand what Medicaid churn is and its impact on the healthcare delivery system including the Medicaid agency, providers, payers and Medicaid beneficiaries

Learn how Medicaid churn can be measured including what data sources can be used to calculate churn

Evaluate the current policy and practice landscape to identify opportunities to establish or advance policies and processes that reduce Medicaid churn

Understand how various types of stakeholders (e.g., managed care organizations, foundations, researchers, advocates) can bring valuable skills and resources to a proposed initiative and  develop a plan for external stakeholder engagement

Assess how the impact of churn can be measured by gathering information about available data sources, and how data are collected, stored, analyzed, and reported

Develop an informed action plan with next steps for implementing proposed churn solutions

Individual Tools

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Each tool within the toolkit can be used as an independent resource and includes detailed instructions for completion including suggestions for the resources needed for completion. The resources in the toolkit include:

Tool: Complete Readiness Assessment

Determine if this is a good fit for your state right now. Assess Leadership Awareness & Overall Motivation for Change and General Capacity & Resource Availability.

Resources needed:


Tool: Set Goals

Establish SMART (Specific, Measurable, Achievable, Relevant, and Time-bound) goals for addressing Medicaid churn.

Resources needed:


Tool: Build the Core Churn Team

Develop a plan for how the team operates — i.e. how team will review tools, data, practices, etc. and move toward implementation of the action plan.

Resources needed:


Tool: Engage External Stakeholders

Identify who needs to be part of the process based on knowledge/expertise & capacity. Identify opportunities for engagement & establish and implement a strategy for engagement.

Resources needed:


Tool: Review Current Landscape

Planning Worksheet 1: Understand how data to measure the burden of churn and its impact are collected, stored, analyzed, and reported.

Planning Worksheet 2: Evaluate the impact of current policies and processes on Medicaid churn.

Resources needed:



Tool: Complete Prioritization Tool & Action Plan

Determine what policy and process solutions are feasible by analyzing the risk, value, cost and effort of implementation and establish action steps for implementing proposed policy & process changes.

Resources needed:


Implement Solutions

Implement policy and process solutions identified in your state’s Medicaid Churn Action Plan.

BDT helped 16 states streamline benefits access in 2020 and stands ready to assist states in using this toolkit to reduce Medicaid churn and prepare for the end of the COVID-19 public health emergency. We are also striving to make this toolkit a dynamic resource and would greatly value your feedback on ways in which we can make this a more useful product. We would like to hear your thoughts on what you did or didn’t like, what can be improved, and what’s missing.

For questions about this toolkit, comments, suggestions, or technical assistance requests please contact Benefits Data Trust at

Support for this project was made possible by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.