The mechanism: When the pandemic-era continuous-enrollment mandate ended in 2023, states spent roughly a year re-checking eligibility for everyone on Medicaid — the "unwind." Thanks to clunky ex parte renewal systems (the process where a state is supposed to verify continued eligibility using existing data, like wage records, without making the enrollee do paperwork), millions were disenrolled for procedural reasons rather than actual ineligibility — kids and adults who likely still qualified but got dropped for a missing form. CMS's April 2024 final rule (CMS-2421-F) forces states to fix exactly that: automate ex parte renewals, cap redetermination frequency, ease income documentation, and simplify CHIP too. States are still phasing in compliance through 2026-27, and every state that tightens its auto-renewal pipeline puts a member back on a Medicaid managed-care plan's roster. That's a straight-line, mechanical revenue event for the insurers that administer these plans — no new law needed, just states executing rules already on the books.