The recent global pandemic has exacerbated deep health disparities across the country, and access to quality health insurance is no exception. At the national level, we fund organizations working to better understand the impact of certain policies and trends on health insurance coverage for children and families. In this report, the Urban Institute explores the anticipated impact of COVID-19 on health insurance coverage, and estimates significant expected losses in coverage due to unemployment, a resulting increase in Medicaid eligibility, but ultimately varied shifts to Medicaid coverage state by state based on whether states expanded Medicaid coverage under the Affordable Care Act. For us, this means an uncertain future for health insurance coverage for children and families, and the urgent need for Medicaid expansion at the state level.