Once the Covid-19 public health emergency ends, a projected 17.4% of Medicaid and Children’s Health Insurance Program enrollees will lose coverage, a new report found. This amounts to about 15 million people.

The U.S. Department of Health & Human Services report, released Tuesday, is based on historical patterns of coverage loss. It used the Survey for Income and Program Participation with data from March 2015 to November 2016.

During the Covid-19 public health emergency, the government implemented a continuous enrollment requirement. This prohibited states from disenrolling Medicaid participants during the emergency period. A recent Kaiser Family Foundation report showed that Medicaid/CHIP enrollment has grown by 23.9% since February 2020. Meanwhile, an HHS report found that the national uninsured rate reached a record low of 8% in early 2022. The changes are partially due to the continuous enrollment provision.

After the public emergency ends and the continuous enrollment requirement is rolled back, about 9.5% of Medicaid enrollees, or 8.2 million people, will leave Medicaid because of a loss in eligibility. Another 7.9% of enrollees, or 6.8 million people, will lose coverage even though they’re eligible, the report said. This is because of “administrative churning,” which refers to the loss of coverage when people have difficulty renewing.

Those who will be most affected by the end of the public health emergency are children, young adults and minority groups. About 5.3 million children and 4.7 million adults ages 18 to 34 will lose Medicaid/CHIP coverage, as will about 4.6 million Latino Americans and 2.2 million Black Americans, HHS predicts.

Of those expected to lose coverage, about one-third will likely qualify for the Affordable Care Act’s Marketplace premium tax credits. More than 60% of these individuals will be eligible for zero-premium Marketplace plans through the American Rescue Plan. Another 5 million people will receive other coverage, mostly through employer-sponsored insurance.

But not everyone will be so lucky, the report said. About 383,000 individuals expected to lose Medicaid eligibility will be in the “coverage gap” in the 12 states that have not expanded Medicaid. These are people who have incomes too high for Medicaid but too low to receive Marketplace tax credits. The states that have not expanded Medicaid are Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin and Wyoming.

“Among the 12 states that have not yet expanded Medicaid, Medicaid expansion to low-income adults is another critical tool to reducing the risk of coverage losses after the [public health emergency],” HHS said.

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