March Spotlight: Project 46
Written by: Diya Sriramagiri
Every month, Project 46 brings attention to a policy that quietly shapes health outcomes for children. This March, the focus is on the Medicaid continuous coverage unwinding, a policy shift that, while administrative on the surface, is already influencing how and when children with cancer receive care. During the COVID-19 pandemic, a federal provision required states to keep individuals continuously enrolled in Medicaid, preventing coverage loss even if eligibility status changed. This created a period of unusual stability for millions of families. However, beginning in 2023, that protection ended. States resumed eligibility checks, initiating what is now referred to as the “unwinding” process.
While intended to restore normal operations, the scale of this transition has been significant. Nationally, over 20 million people were expected to lose Medicaid coverage, with millions of children affected. According to KFF (Kaiser Family Foundation), a majority of these disenrollments, nearly 65–70% are due to procedural issues, such as missed paperwork or administrative barriers, rather than true loss of eligibility. For pediatric cancer patients, this distinction matters. Cancer treatment in children is not a one-time event. It is a continuous process involving chemotherapy cycles, imaging, specialist visits, and long-term monitoring. Even a short gap in insurance coverage can delay appointments, interrupt treatment schedules, or limit access to pediatric oncology specialists. In a disease where timing directly affects outcomes, these disruptions are not minor, they are consequential.
Public insurance programs like Medicaid and Medi-Cal play a central role in pediatric cancer care. In the United States, a significant proportion of children diagnosed with cancer rely on public insurance at some point during treatment. Data from the Children’s Hospital Association shows that Medicaid covers a large share of children with complex medical conditions, including cancer, making coverage stability essential for ongoing care. The impact of Medicaid unwinding is not evenly distributed. Geography plays a critical role in how families experience coverage loss. In rural or underserved areas, families often face longer distances to pediatric oncology centers, fewer providers who accept public insurance, and limited access to enrollment assistance. Research from the National Cancer Institute highlights that rural patients experience reduced access to specialized cancer care, increasing the risk of delayed treatment.
These challenges are compounded by the scale of pediatric coverage loss. According to the Georgetown University Health Policy Institute, millions of children are at risk of losing Medicaid coverage during the unwinding process, increasing the likelihood of gaps in care and interruptions in treatment continuity. The consequences extend beyond individual cases. Coverage instability has been linked to delayed diagnoses, increased reliance on emergency care, and poorer long-term outcomes. Research supported by the National Institutes of Health (NIH) demonstrates that interruptions in insurance coverage are associated with reduced access to timely care and worse health outcomes an especially critical issue in pediatric cancer.
The Medicaid unwinding process reveals a gap between policy design and lived experience. While eligibility rules may remain unchanged, the administrative burden placed on families creates barriers that disproportionately affect those already navigating complex health conditions. In this context, continuity of coverage becomes just as important as coverage itself. Project 46 centers its work on translating policies like this into real-world impact. By examining how administrative decisions influence access to care, the initiative aims to highlight where systems fall short and where change is needed. The unwinding process is not simply a return to pre-pandemic norms; it is a test of whether healthcare systems can maintain stability for the most vulnerable patients during periods of transition. As policymakers and healthcare leaders continue to evaluate the effects of Medicaid unwinding, there is an opportunity to rethink how coverage is maintained for children with serious illnesses. Simplifying renewal processes, increasing outreach, and implementing protections for medically complex patients are not just administrative improvements, they are interventions that can directly affect health outcomes.
Works Cited
“Center for Children and Families.” Center for Children and Families, ccf.georgetown.edu/. kffpatrickd. “Medicaid Enrollment and Unwinding Tracker | KFF.” KFF, 28 July 2025, www.kff.org/medicaid/medicaid-enrollment-and-unwinding-tracker/.
National Cancer Institute. “About NCI - Overview and Mission.” National Cancer Institute, Cancer.gov, 6 Apr. 2018, www.cancer.gov/about-nci/overview.
