Study Finds Medicaid Drop-Off at Age 19

Researchers observe sharp spike in Medicaid disenrollment when young adults transition from child to adult classification.

Published on Feb. 24, 2026

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A new study led by the University of Chicago finds that the policy threshold of turning 19 and transitioning from child to adult Medicaid classification coincides with a sharp spike in Medicaid disenrollment, exposing millions of young adults - including those with significant health needs - to potential gaps in insurance coverage.

Why it matters

While young adults without complex conditions were more likely to lose coverage, disruptions among medically complex patients remain clinically significant. Over a three-year window between ages 19 and 21, the cumulative probability of disenrollment reached 37.9% for individuals with complex medical conditions and 74.2% for those without.

The details

The study also found dramatic differences in disenrollment rates based on geography, with the probability of disenrollment at age 19 varying widely by state from 2.6% to 37% for young adults with complex medical conditions and 7.3% to 83.9% for those without. Researchers identified other factors associated with higher disenrollment risk, including being male, qualifying through income-based eligibility pathways rather than disability-based pathways, living in states that have not expanded Medicaid, and residing in states where managed care dominates.

  • The study was published on February 16, 2026 in JAMA Pediatrics.

The players

Betsy Q. Cliff

PhD, Assistant Professor of Public Health Sciences at the University of Chicago and lead author of the study.

University of Chicago

The institution that led the research study on Medicaid disenrollment at age 19.

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What they’re saying

“It was known within health policy that there was increased disenrollment around age 19, but we're the first we know of to estimate the precise risk across this transition from childhood to adulthood for a national Medicaid population.”

— Betsy Q. Cliff, PhD, Assistant Professor of Public Health Sciences (JAMA Pediatrics)

“I was really surprised at the variation among states. Two equally sick people living in different places can have a very different probability of losing health insurance.”

— Betsy Q. Cliff, PhD, Assistant Professor of Public Health Sciences (JAMA Pediatrics)

What’s next

Further research will examine where disenrolled individuals go and how coverage disruptions shape long-term health outcomes.

The takeaway

This study highlights the instability many young adults face when transitioning from child to adult Medicaid coverage, with significant variation across states and risk factors like complex medical conditions, gender, and eligibility pathways. Policymakers may need to consider ways to support a more seamless transition to prevent gaps in insurance and potential worsening of health outcomes.