Science
Halfway through Medicaid purge, enrollment is down about 10 million
Halfway through what will be the biggest purge of Medicaid beneficiaries in a one-year span, enrollment in the government-run health insurance program is on track to return to roughly pre-pandemic levels.
Medicaid, which covers low-income and disabled people, and the related Children’s Health Insurance Program grew to a record 94 million enrollees as a result of a rule that prohibited states from terminating coverage during the nation’s public health emergency.
But since last April, states have removed more than 16 million people from the programs in a process known as the “unwinding,” according to KFF estimates compiled from state-level data.
While many beneficiaries no longer qualify because their incomes rose, millions of people have been dropped from the rolls for procedural reasons like failing to respond to notices or return paperwork. But at the same time, millions have been reenrolled or signed up for the first time.
The net result: Enrollment has fallen by about 9.5 million people from the record high reached last April, according to KFF. That puts Medicaid and CHIP enrollment on track to look, by the end of the unwinding later this year, a lot like it did at the start of the coronavirus pandemic: about 71 million people.
“What we are seeing is not dissimilar to what we saw before the pandemic — it is just happening on a bigger scale and more quickly,” said Larry Levitt, executive vice president for health policy at KFF.
Enrollment churn has long been a feature of Medicaid. Before the pandemic, about 1 million to 1.5 million people nationwide fell off the Medicaid rolls each month — including many who still qualified but failed to renew their coverage, Levitt said.
During the unwinding, many people have been disenrolled in a shorter time. In some ways — and in some states — it’s been worse than expected.
The Biden administration predicted about 15 million people would lose coverage under Medicaid or CHIP during the unwinding period, nearly half due to procedural issues. Both predictions have proved low. Based on data reported so far, disenrollments are likely to exceed 17 million, according to KFF — 70% due to procedural reasons.
But about two-thirds of the 48 million beneficiaries who have had their eligibility reviewed so far got their coverage renewed. About one-third lost it.
The federal government has given most states 12 months to complete their unwinding, starting with the first disenrollments between last April and October.
Timothy McBride, a health economist at Washington University in St. Louis, said the nation’s historically low unemployment rate means people who lose Medicaid coverage are more likely to find job-based coverage or be better able to afford plans on Obamacare marketplaces. “That is one reason why the drop in Medicaid is not a lot worse,” he said.
There are big differences between states. Oregon, for example, has disenrolled just 12% of its beneficiaries. Seventy-five percent have been renewed, according to KFF. The rest are pending.
At the other end of the spectrum, Oklahoma has dumped 43% of its beneficiaries in the unwinding, renewing coverage for just 34%. About 24% are pending.
States have varying eligibility rules, and some make it easier to stay enrolled. For instance, Oregon allows children to stay on Medicaid until age 6 without having to reapply. All other enrollees get up to two years of coverage regardless of changes in income.
Jennifer Harris, senior health policy advocate for Alabama Arise, an advocacy group, said her state’s Medicaid agency and other nonprofit organizations communicated well to enrollees about the need to reapply for coverage and that the state also hired more people to handle the surge. About 29% of beneficiaries in Alabama who’ve had eligibility reviews were disenrolled for procedural reasons, KFF found.
“Things are even keel in Alabama,” she said, noting that about 66% of enrollees have been renewed.
State officials have told the legislature that about a quarter of people disenrolled during the unwinding were reenrolled within 90 days, she said.
One of a handful of states that have refused to expand Medicaid under the Affordable Care Act, Alabama had about 920,000 enrollees in Medicaid and CHIP in January 2020. That number rose to about 1.2 million in April 2023.
More than halfway into the unwinding, the state is on track for enrollment to return to pre-pandemic levels, Harris said.
Joan Alker, executive director of the Georgetown University Center for Children and Families, said she remains worried the drop in Medicaid enrollment among children is steeper than typical. That’s particularly bothersome because children usually qualify for Medicaid at higher household income levels than their parents or other adults.
During the unwinding 3.8 million children have lost Medicaid coverage, according to the center’s latest data. “Many more kids are falling off now than prior to the pandemic,” Alker said.
And when they’re dropped, many families struggle to get them back on, she said. “The whole system is backlogged and the ability of people to get back on in a timely fashion is more limited,” she said.
The big question, Levitt said, is how many of the millions of people dropped from Medicaid are now uninsured.
The only state to survey those disenrolled — Utah — discovered about 30% were uninsured. Many of the rest found employer health coverage or signed up for subsidized coverage through the Affordable Care Act marketplace.
What’s happened nationwide remains unclear.
KFF Health News, formerly known as Kaiser Health News, is a national newsroom that produces in-depth journalism about health issues.
Science
Why California’s milk cartons may lose their coveted recycling symbol
California milk cartons may lose their coveted recycling symbol, the one with the chasing arrows, potentially threatening the existence of the ubiquitous beverage containers.
In a letter Dec. 15, Waste Management, one of the nation’s largest waste companies, told the state the company would no longer sort cartons out of the waste stream for recycling at its Sacramento facility. Instead, it will send the milk- and food-encrusted packaging to the landfill.
Marcus Nettz, Waste Management’s director of recycling for Northern California and Nevada, cited concerns from buyers and overseas regulators that cartons — even in small amounts — could contaminate valuable material, such as paper, leading them to reject the imports.
The company decision means the number of Californians with access to beverage carton recycling falls below the threshold in the state’s “Truth in Recycling” law, or Senate Bill 343.
And according to the law, that means the label has to come off.
The recycling label is critical for product and packaging companies to keep selling cartons in California as the state’s single-use packaging law goes fully into effect. That law, Senate Bill 54, calls for all single-use packaging to be recyclable or compostable by 2032. If it isn’t, it can’t be sold or distributed in the state.
The labels also provide a feel-good marketing symbol suggesting to consumers the cartons won’t end up in a landfill when they’re discarded, or find their way into the ocean where plastic debris is a large and growing problem.
On Tuesday, the state agency in charge of waste, CalRecycle, acknowledged Waste Management’s change.
In updated guidelines for the Truth in Recycling law, recycling rates for carton material have fallen below the state threshold.
It’s a setback for carton manufacturers and their customers, including soup- and juice-makers. Their trade group, the National Carton Council, has been lobbying the state, providing evidence that Waste Management’s Sacramento Recycling and Transfer Station successfully combines cartons with mixed paper and ships it to Malaysia and other Asian countries including Vietnam, proving that there is a market. The Carton Council persuaded CalRecycle to reverse a decision it made earlier this year that beverage cartons did not meet the recycling requirements of the Truth in Recycling law.
Brendon Holland, a spokesman for the trade group, said in an email that his organization is aware of Waste Management’s decision, but its understanding is that the company will now sort the cartons into their own dedicated waste stream “once a local end market is available.”
He added that even with “this temporary local adjustment,” food and beverage cartons are collected and sorted in most of California, and said this is just a “temporary end market adjustment — not a long-term shift away from historical momentum.”
In 2022, Malaysia and Vietnam banned imports of mixed paper bales — which include colored paper, newspapers, magazines and other paper products — from the U.S. because they were so often contaminated with non-paper products and plastic, such as beverage cartons. Waste Management told The Times on Dec. 5 that it has a “Certificate of Approval” by Malaysia’s customs agency to export “sorted paper material.” CalRecycle said it has no regulatory authority on “what materials may or may not be exported.”
Adding the Sacramento facility to the list of waste companies that were recycling cartons meant that the threshold required by the state had been met: More than 60% of the state’s counties had access to carton recycling.
At the time, CalRecycle’s decision to give the recycling stamp to beverage cartons was controversial. Many in the environmental, anti-plastic and no-waste sectors saw it as a sign that CalRecycle was doing the bidding of the plastic and packaging industry, as opposed to trying to rid the state of non-recyclable, polluting waste — which is not only required by law, but is something state Atty. Gen. Rob Bonta is investigating.
Others said it was a sign that the Truth in Recycling law was working: Markets were being discovered and in some cases, created, to provide recycling.
“Recyclability isn’t static, it depends on a complicated system of sorting, transportation, processing, and, ultimately, manufacturers buying the recycled material to make a new product,” said Nick Lapis, director of advocacy for Californians Against Waste.
He said this new information, which will likely remove the recycling label from the cartons, also underscores the effectiveness of the law.
“By prohibiting recyclability claims on products that don’t get recycled, SB 343 doesn’t just protect consumers. It forces manufacturers to either use recyclable materials or come to the table to work with recyclers, local governments and policymakers to develop widespread sustainable and resilient markets,” he said.
Beverage and food cartons — despite their papery appearance — are composed of layers of paper, plastic and sometimes aluminum. The sandwiched blend extends product shelf life, making it attractive to food and beverage companies.
But the companies and municipalities that receive cartons as waste say the packaging is problematic. They say recycling markets for the material are few and far between.
California, with its roughly 40 million residents, has some of the strictest waste laws in the nation. In 1989, the state passed legislation requiring cities, towns and municipalities to divert at least 50% of their residential waste away from landfills. The idea was to incentivize recycling and reuse. However an increasing number of products have since entered the commercial market and waste stream — such as single use plastics, polystyrene and beverage cartons — that have limited (if any) recycling potential, can’t be reused, and are growing in number every year.
Fines for municipalities that fail to achieve the required diversion rates can run $10,000 a day.
As a result, garbage haulers often look for creative ways to deal with the waste, including shipping trash products overseas or across the border. For years, China was the primary destination for California’s plastic, contaminated paper and other waste. But in 2018, China closed its doors to foreign garbage, so U.S. exporters began dumping their waste in smaller southeast Asian countries, including Malaysia and Vietnam.
They too have now tried to close the doors to foreign trash as reports of polluted waterways, chokingly toxic air, and illness grows — and as they struggle with inadequate infrastructure to deal with their own domestic waste.
Jan Dell, the founder and CEO of Last Beach Cleanup, released a report with the Basel Action Network, an anti-plastic organization, earlier this month showing that the Sacramento facility and other California waste companies were sending bales of carton-contaminated paper to Malaysia, Vietnam and other Asian nations.
According to export data, public records searches and photographic evidence collected by Dell and her co-authors at the Basel Action Network, more than 117,000 tons or 4,126 shipping containers worth of mixed paper bales were sent by California waste companies to Malaysia between January and July of this year.
Dell said these exports violate international law. A spokesman for Waste Management said the material they were sending was not illegal — and that they had received approval from Malaysia.
However, the Dec. 15 letter suggests they were receiving more pushback from their export markets than they’d previously disclosed.
“While certain end users maintain … that paper mills are able to process and recycle cartons,” some of them “have also shared concerns … that the inclusion of cartons … may result in rejection,” wrote Nettz.
Dell said she was “pleased” that Waste Management “stopped the illegal sortation of cartons into mixed paper bales. Now we ask them and other waste companies to stop illegally exporting mixed paper waste to countries that have banned it.”
Science
Video: Why Scientists Are Performing Brain Surgery on Monarchs
new video loaded: Why Scientists Are Performing Brain Surgery on Monarchs
By Alexa Robles-Gil, Leila Medina, Joey Sendaydiego and Mark Felix
December 23, 2025
Science
Video: Engineer Is First Paraplegic Person in Space
new video loaded: Engineer Is First Paraplegic Person in Space
transcript
transcript
Engineer Is First Paraplegic Person in Space
A paraplegic engineer from Germany became the first wheelchair user to rocket into space. The small craft that blasted her to the edge of space was operated by Jeff Bezos’ company Blue Origin.
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Capsule touchdown. There’s CM 7 Sarah Knights and Jake Mills. They’re going to lift Michi down into the wheelchair, and she has completed her journey to space and back.
December 21, 2025
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