Medicaid Statistics in US 2026 | Key Facts

Medicaid in America 2026

Medicaid remains the backbone of the American healthcare safety net, quietly covering tens of millions of people who would otherwise fall through every crack in the system. Born in 1965 under Title XIX of the Social Security Act, the program has grown from a modest state-federal partnership into the single largest source of health coverage in the United States, outpacing even employer-sponsored insurance for low-income populations. In 2026, the program is navigating one of its most turbulent chapters — a post-pandemic enrollment correction, aggressive federal budget negotiations, and new legislative pressures under the “One Big Beautiful Bill Act” — yet it continues to serve as the primary insurer for approximately 77 million Americans as of the latest CMS data.

What makes Medicaid in 2026 particularly fascinating is how much has shifted since the COVID-19 continuous enrollment provision ended in March 2023. At its pandemic peak, Medicaid and CHIP together enrolled a record 94 million people — a figure driven by a federal mandate that blocked states from removing anyone from the rolls. Since the unwinding began, over 25 million individuals have been disenrolled, though enrollment remains well above pre-pandemic levels. The program is simultaneously under fiscal scrutiny, with Congress debating cuts exceeding $1.2 trillion over a decade, while also serving as the primary payer for long-term care, behavioral health, and births across the country. The data tells a complex story — not just of numbers, but of real people whose health and financial security depend on whether this program stays intact.

Interesting Facts About Medicaid in the US 2026

Source: CMS Medicaid & CHIP Monthly Enrollment Data (Medicaid.gov), KFF Medicaid Enrollment & Unwinding Tracker, CMS 2026 Medicaid and CHIP Beneficiary Profile (Released January 2026), Congressional Research Service Report R42640 (Updated May 2025), CBO June 2024 Baseline Projections.

The numbers in the table above frame a program of extraordinary scale and social weight. The fact that Medicaid covers nearly 77 million people — even after a historic post-pandemic contraction — underscores how deeply embedded the program has become in the American healthcare landscape. The pandemic peak of 94 million enrollees was not sustainable under normal eligibility rules, and the unwinding process has been both necessary and painful, with 25+ million disenrollments since April 2023. Yet today’s enrollment remains 7% above the February 2020 pre-pandemic baseline, suggesting that many people who enrolled during the pandemic were genuinely eligible all along and simply hadn’t been connected to the program previously.

What stands out equally is the financial magnitude: a combined federal and state expenditure of $894 billion in FY 2023 makes Medicaid one of the largest single items in all of American government spending. The $691 billion federal cost for Medicaid and CHIP combined in 2025 eclipses the entire defense budgets of most nations. The transition to managed care dominance — with 84.8% of enrollees now receiving care through managed care organizations — reflects decades of state-level decisions to shift from fee-for-service models toward cost-managed delivery systems, with mixed but generally favorable results on access and cost containment.

Medicaid Enrollment Trends in the US 2026

Source: CMS, September 2025 and October 2025 Medicaid and CHIP Eligibility Operations and Enrollment Snapshots (Medicaid.gov); CMS April 2025 Medicaid and CHIP Eligibility Operations and Enrollment Snapshot; KFF Medicaid Enrollment and Unwinding Tracker (Updated January 2026).

The enrollment trend data reveals a program that has contracted sharply from its pandemic high but is stabilizing at a level meaningfully above where it stood before COVID-19. The month-over-month contraction from 78.4 million in April to 76.8 million by October 2025 reflects the ongoing — though largely complete — unwinding process, as states finalize eligibility redeterminations for enrollees who may no longer qualify. This downward drift is slower than in 2023 and early 2024, suggesting the bulk of ineligible individuals have already been removed, and the remaining caseload represents people with genuine need. The 14% year-over-year increase in applications in April 2025 is particularly telling: despite lower total enrollment, more Americans are applying, pointing to sustained demand driven by economic uncertainty, job changes, and awareness of the program.

The divergence between adult enrollment (up 20% from pre-pandemic) and child enrollment (up only 6%) is equally revealing. Much of Medicaid’s structural growth over the past decade has been in the adult population, largely through ACA Medicaid expansion which opened the program to low-income adults without children for the first time. The fact that adult enrollment grew three times faster than child enrollment since 2020 reflects both the expansion’s ongoing impact and the changing demographic composition of economic vulnerability in America. Adults in the working-age population — gig workers, part-time employees, unhoused individuals, and caregivers — have increasingly come to rely on Medicaid as a primary source of coverage.

Medicaid Expenditures and Spending in the US 2026

Source: CMS, Form CMS-64 Financial Management Reports; Congressional Research Service Report R42640 (Updated May 2025); KFF Medicaid Enrollment & Spending Growth FY 2025 & 2026 (December 2025); CBO Baseline Projections; Committee for a Responsible Federal Budget (February 2026).

The spending numbers confirm that Medicaid is one of the most expensive domestic programs in U.S. government history, and that cost pressures are intensifying even as enrollment falls. The 12.2% growth in state Medicaid spending in FY 2025 — despite declining enrollment — illustrates the core tension states now face: enrollee counts may be lower, but each remaining enrollee is costlier to serve. People who maintained eligibility through the unwinding tend to have more complex, chronic health needs, higher utilization of behavioral health services, and greater reliance on long-term care. Rate increases, post-pandemic provider cost escalation, and rising pharmacy costs are all pushing spending upward in ways that enrollment figures alone cannot capture.

The passage of the “One Big Beautiful Bill Act” in 2025 introduced $1.2 trillion in projected Medicaid savings over a decade, primarily through restrictions on provider taxes, state-directed payments, eligibility constraints, and the introduction of community engagement (work) requirements beginning in 2027. While this will moderate federal expenditure growth, states are already grappling with the implications — most enacted their FY 2026 budgets before the bill’s passage, meaning operational and fiscal adjustments are still being absorbed. With the projected federal Medicaid + CHIP cost growing toward $996 billion by 2036 even after these cuts, long-term cost control remains an unsolved challenge for policymakers across the political spectrum.

Medicaid Managed Care Enrollment in the US 2026

Source: CMS, 2024 Medicaid Managed Care Enrollment and Program Characteristics (Winter 2026 Edition, Medicaid.gov); Health Management Associates (HMAIS), Q4 2024 and Q1 2025 Medicaid Managed Care Enrollment Updates.

The managed care landscape reflects the broader enrollment decline playing out across Medicaid. With 84.8% of all Medicaid enrollees now receiving care through managed care organizations — a figure from the official CMS 2024 Managed Care Enrollment Report released in Winter 2026 — the shift away from fee-for-service Medicaid is nearly complete in most states. Managed care has become the default delivery system, with comprehensive MCOs covering acute, primary, specialty, and in some states, behavioral health and long-term services. The 5.5% year-over-year decline in managed care enrollment in the 29 states tracked by HMA mirrors the overall unwinding of pandemic-era enrollment, but the pace is slowing: by March 2025, the year-over-year contraction had narrowed to 3.9%, suggesting the market is approaching stabilization.

The concentration of market share among a small number of publicly traded plans — with Centene, Elevance, and United controlling over 37% of the tracked market — is a defining feature of how managed care Medicaid has evolved. States have benefited from competitive bidding and performance incentives, but the consolidation raises long-term policy questions about plan accountability, administrative overhead, and whether profit-driven models serve the most complex, high-need Medicaid populations well. As Congress debates work requirements and eligibility restrictions expected to take effect in 2027, managed care organizations are actively stress-testing their enrollment projections and preparing for another round of structural shifts.

Medicaid ACA Expansion Statistics in the US 2026

Source: KFF, Status of State Medicaid Expansion Decisions; KFF, Medicaid Expansion: Frequently Asked Questions (Updated 2025); Center on Budget and Policy Priorities, Medicaid Expansion FAQ; HealthCare.gov; Congressional Research Service R42640 (May 2025).

The ACA Medicaid expansion remains one of the most consequential domestic policy decisions of the past two decades, and in 2026, its reach — and its limits — are sharper than ever. With 40 states plus Washington D.C. having adopted expansion, approximately 20.7 million adults now have coverage they wouldn’t have had before 2014. These are primarily low-income working-age adults — many of them employed in service, gig, agriculture, and caregiving sectors — who previously had no coverage pathway. The 90% federal match rate makes expansion the most favorable fiscal deal available to states in all of Medicaid, and yet 10 states have still declined to participate, leaving an estimated 1.4 million Americans stuck in a coverage gap where they earn too little for marketplace subsidies but too much for traditional Medicaid.

The decision by South Dakota and North Carolina to expand in 2023 marked a significant milestone — bringing red-leaning and politically divided states into the expansion fold through ballot initiatives and legislative shifts. But no new states expanded in 2024 or 2025, and the policy horizon has grown more uncertain. The “One Big Beautiful Bill Act” of 2025 introduced community engagement (work) requirements for expansion adults, slated to take effect in 2027. For Medicaid expansion — which was designed to protect low-income adults from the precarity of uncompensated medical costs — the work requirements signal a philosophic reorientation that will be watched closely by states, health systems, and coverage advocates as implementation approaches.

Medicaid Demographics and Beneficiary Characteristics in the US 2026

Source: CMS, 2026 Medicaid and CHIP Beneficiary Profile (Released January 2026, Medicaid.gov); CMS October 2025 Medicaid & CHIP Enrollment Data Highlights; CBO June 2024 Baseline Projections (Medicaid); National Association of Medicaid Directors, Top Five Medicaid Budget Pressures (2025).

The demographic profile of Medicaid in 2026 tells a powerful story about the program’s true purpose and distribution of costs. Children make up nearly half of all Medicaid and CHIP enrollees — nearly 36.7 million kids — yet because children are generally healthier and cheaper to cover, they account for a disproportionately small share of expenditures. In sharp contrast, older adults and people with disabilities make up only 22% of total membership but consume over 50% of total Medicaid dollars, reflecting the enormous per-capita cost of long-term care, institutional services, and complex health management for these populations. The CBO’s per-beneficiary spending estimates drive this point home starkly: a disabled enrollee costs $21,200 in federal spending annually, nearly ten times what a child costs ($2,280).

The statistic that Medicaid pays for approximately 42% of all U.S. births is one of the most underappreciated facts about the program. Medicaid is not simply a safety net for the destitute — it is the de facto maternity insurer for a significant portion of American families, particularly those in rural areas, minority communities, and working-class households that earn too little to afford private insurance premiums but too much for traditional welfare. The geographic variation is equally striking: at the extremes, one state enrolls 75% of its child population in Medicaid/CHIP while another enrolls fewer than 19%, reflecting profound differences in eligibility generosity, political will, and state fiscal capacity. These disparities in coverage directly correlate with health outcome disparities that persist across state lines.

Medicaid Spending Growth Trends in the US 2026

Source: KFF, Medicaid Enrollment & Spending Growth: FY 2025 & 2026 (December 5, 2025); Committee for a Responsible Federal Budget, CBO Projects High Federal Health Program Costs (February 2026); CBO June 2024 Medicaid Baseline Projections; Congressional Research Service R42640 (May 2025).

The spending growth trends in Medicaid for 2025 and 2026 reveal a fundamental mismatch: enrollment is falling but spending is rising, and the gap between the two is widening. The 12.2% growth in state Medicaid spending in FY 2025 — despite millions fewer enrollees — reflects what economists call “acuity creep”: as healthier, easier-to-cover people were disenrolled during the unwinding, the remaining population skews sicker, older, more disabled, and more reliant on expensive services. Long-term care costs, behavioral health utilization, and post-pandemic provider rate increases have all compounded this structural dynamic. The projected 8.5% growth in FY 2026 represents a slowing but not a reversal of this trend, meaning states are absorbing sustained cost pressure at a time when general fund revenue growth is modest.

The longer-term trajectory is equally challenging. Even with $1.2 trillion in ten-year OBBBA savings, the CBO projects federal Medicaid and CHIP spending to reach $996 billion by 2036 — nearly doubling from FY 2023 totals. The 4.7% annual per-beneficiary cost growth outpacing the 3.6% overall spending growth rate makes clear that cost containment through eligibility restrictions alone cannot bend the curve. Healthcare inflation, an aging population, and the increasing complexity of the Medicaid caseload are structural forces that policy changes alone cannot fully offset. For state Medicaid directors, the budget picture heading into FY 2026 and beyond is one where nearly two-thirds of states anticipate a shortfall — a warning signal that cannot be dismissed.

Medicaid and Long-Term Care in the US 2026

Source: CMS, 2026 Medicaid and CHIP Beneficiary Profile (Released January 2026); National Association of Medicaid Directors, Top Five Medicaid Budget Pressures (June 2025); CBO June 2024 Medicaid Baseline Projections; CMS Financial Report FY 2024.

Medicaid’s role as the dominant funder of long-term care in the United States is a dimension of the program that rarely gets the public attention it deserves. Unlike Medicare, which covers only short-term skilled nursing or rehabilitation stays, Medicaid pays for custodial care — the ongoing personal and nursing assistance that millions of elderly and disabled Americans need for daily living. This includes nursing home care, adult day programs, and increasingly, home and community-based services (HCBS) that allow people to remain in their homes rather than institutionalized settings. With 33 million Americans now between the ages of 65 and 74 — more than 50% more than in 2010 — the long-term care cost wave facing Medicaid is not hypothetical; it is a near-term demographic certainty.

The concentration of over 50% of all Medicaid expenditures on just 22% of enrollees — the aged and disabled — is perhaps the defining financial reality of the program. A dual-eligible beneficiary navigates one of the most complex healthcare arrangements in existence, simultaneously enrolled in both Medicare and Medicaid, with coordination of benefits that can confuse even experienced healthcare administrators. The $21,200 average annual federal cost per disabled enrollee versus $2,280 per child illustrates why per-beneficiary cost growth consistently outstrips enrollment growth: the most expensive beneficiaries are not going away, and their needs only deepen with age and disease progression. Medicaid’s long-term care mission is both its most critical function and its most formidable fiscal challenge.

Disclaimer: This research report is compiled from publicly available sources. While reasonable efforts have been made to ensure accuracy, no representation or warranty, express or implied, is given as to the completeness or reliability of the information. We accept no liability for any errors, omissions, losses, or damages of any kind arising from the use of this report.

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