About 15 million Americans could lose Medicaid health insurance coverage as states unwind the “continuous coverage requirement” implemented at the beginning of the COVID-19 pandemic to ensure people retained health benefits, a new analysis from the Kaiser Family Foundation shows.

The federal government has called the expiration of the coverage requirement, first authorized by the Families First Coronavirus Response Act, the “the single largest health coverage transition event since the first open enrollment period of the Affordable Care Act.” The move paused disenrollment from Medicaid in February 2020 at the pandemic’s beginning and has contributed to a boom in growth of health insurance for low income Americans to nearly 95 million by the end of this month when the continuous enrollment provision ends.

“Millions of beneficiaries are expected to be disenrolled over the next year, including some who are no longer eligible for Medicaid and others who still qualify but lose coverage due to administrative paperwork problems,” the Kaiser Family Foundation, which worked with the Georgetown University Center for Children and Families, to survey states on how they would disenroll people from Medicaid, as part of the 21st annual KFF survey of state Medicaid and Children’s Health Insurance Program (CHIP) report, which was issued Thursday.

“One-third of states that were able to report projected coverage losses estimate that about 18% of Medicaid enrollees will be disenrolled after the continuous enrollment provision ends,” Kaiser said. “The estimates range from 7% to 33% of total enrollees and are consistent with other estimates that about 15 million people may lose Medicaid coverage over the coming year.”

Aside from Americans including children and families who could lose coverage, the coming loss of Medicaid recipients is on the minds of health insurance companies across the country that could lose business. Executives from UnitedHealth Group, Centene, Elevance Health, CVS Health’s Aetna health insurance unit and a host of other companies are regularly peppered with questions from Wall Street analysts about the coming end to the continuous coverage provision.

But it’s difficult to know exactly how many Americans will lose Medicaid coverage and when because states, which administer such health benefits, have different plans and strategies, the Kaiser analysis shows. Meanwhile, some states are making it easier for people remain eligible to keep their coverage while others are making it more difficult, the Kaiser analysis showed.

The process will be slow with 43 states “taking 12-14 months to complete renewals following the end of the continuous enrollment provision,” the Kaiser analysis said.

Here’s a link to the entire Kaiser 50-state Medicaid survey.