Georgetown CCF has been closely tracking Medicaid and CHIP enrollment periodically over the past decade, – most recently as states began “unwinding” continuous coverage protections put in place during the pandemic. Now, as states prepare to implement H.R.1, including mandatory work reporting requirements and more frequent renewals for people covered through Medicaid expansion, while mixed-status and immigrant families navigate a very hostile climate with developments such as CMS granting ICE access to Medicaid data and proposed changes to the public charge rule, we are watching enrollment again very closely. In this rapidly evolving policy environment, enrollment trends provide a critical early warning sign that something is amiss.
To help policymakers, stakeholders, and researchers monitor enrollment trends as states implement new policies, CCF is launching an expanded 50-state Medicaid and CHIP enrollment tracker.
The tracker uses the most recent monthly administrative data from state websites and the Centers for Medicare & Medicaid Services (CMS) and allows users to view total Medicaid/CHIP enrollment by state as well as trends for children, adults, and Medicaid expansion adults, where applicable. State administrative data is often the quickest way to assess what is happening in a state’s Medicaid program – as well as nationwide. Not every state posts its enrollment data or maintains comparable data for previous months or years, so we substitute the most recent data from CMS in some states and for historical data where necessary.
Our current tracking begins with a January 2025 baseline; historical data are also available to provide additional context for state enrollment trends back to December 2019. Currently, all states have data through at least October 2025, and some states have posted data as recently as January 2026. We will be updating the tracker every month as new data become available. Additional details about the methodology are available here.
Data so far indicate that Medicaid/CHIP enrollment declined by approximately 3.3 million individuals (or 4.0%) during 2025. While this rate of decline is more modest than in the previous two years, it still marks the third straight year of enrollment declines following the unwinding of the pandemic-era continuous coverage protections which began April 1, 2023. (Nationally, enrollment declined by about 8% between December 2022 and December 2023 and by 7% between December 2023 and December 2024). Importantly, the child uninsured rate went up from 5.1% in 2022 to 6.0% in 2024 as we documented in our annual child coverage report. The majority of children losing coverage during unwinding were expected to remain eligible. The adult uninsured rate did not change in 2024.
Medicaid enrollment typically increases as unemployment rises and more people become income-eligible, but these enrollment losses occurred as the unemployment rate modestly rose from 4.0% in January to 4.4% in December 2025. Unemployment rates increased in several of the industries already employing low-wage uninsured workers including construction, retail, transportation, and education and health services, and also increased considerably for Black workers – worrying trends for both expansion and non-expansion states. States can apply for hardship exceptions from work reporting requirements for people in counties with high unemployment; however, this is not an automatic exemption.
As of October 2025 (the most recent month for which all states have data), 36.4 million children were enrolled in Medicaid/CHIP—one million fewer than were enrolled in the beginning of 2025 (2.7% decline). During this period, 47 states and the District of Columbia saw child enrollment declines, with Alaska, Indiana, Wyoming, South Dakota and Virginia experiencing the largest percentage decreases.
Child enrollment losses during unwinding varied considerably by state, largely driven by wide differences in state performance related to eligibility and enrollment. This is one reason it is so important to track each state in real time as new eligibility restrictions are enacted. It also means that states started 2025 in different places with respect to how many children and adults have already lost Medicaid coverage while still eligible.
Continued declines for children in 2025 are troubling as it is unlikely that many of these children have moved to affordable employer-sponsored dependent coverage, the cost of which continues to rise. One possible explanation is a “chilling effect” – whereby mixed-status families with citizen children are reluctant to enroll them in public coverage for fear of negative consequences. With one in four children in the US living in a mixed-status family, the chilling effect could have significant consequences for the child uninsured rate. We will be working with our newest colleague, Steven Lopez, to explore this hypothesis.
Among expansion adults, nearly 400,000 fewer individuals were enrolled in the first half of 2025, a 2.0% decrease between January and June 2025. The biggest declines occurred in Alaska, Massachusetts, Indiana, Maryland, and Arizona.
New restrictions placed on the Medicaid expansion group under H.R. 1, such as work reporting requirements, more frequent renewals, mandatory cost-sharing, and other paperwork and verification hurdles will go into effect as of January 1, 2027; a few states such as Nebraska (5/1/26) and Montana (7/1/26) are planning to start early.
Stay tuned as CCF experts will be unpacking these enrollment trends in the months ahead. Find the tracker and explore more state enrollment data here.