Medicaid enrollment is at an all-time high. Millions may soon get kicked off.

Medicaid coverage swelled during the COVID-19 pandemic, with almost one in four Americans now covered by the health insurance plan for low-income people. But as many as 15 million people may be at risk of losing coverage this year as a pandemic rule winds down. 

Before the public health crisis, U.S. states regularly reviewed Medicaid recipients' eligibility to verify they still qualified for coverage based on requirements such as state residency and income. The latter varies by state, but is typically about 138% of the federal poverty rate. For instance, a single person in California can't earn more than $17,609 a year to qualify.

But during the pandemic, a provision in the Families First Coronavirus Response Act hit the pause button on those eligibility status checks, ensuring continuous Medicaid coverage for recipients during the pandemic. As millions lost their jobs and often their health insurance, many signed up for Medicaid coverage. That helped swell the program's rolls to a record 76.7 million recipients as of July 2021 (the most recent data available), a jump of 19% since 2019.