The “Big Five” have announced their results for the calendar quarter ending June 30. They are, of course, the five publicly-traded companies with the largest presence in the Medicaid managed care market, together accounting for about half of all Medicaid enrollees: Centene Corporation, CVS Health/Aetna, Elevance Health, Molina Healthcare, and UnitedHealth Group. The Medicaid market is in the process of being dramatically reshaped by the 2025 budget reconciliation legislation, H.R. 1. In particular, the law’s provisions relating to work reporting requirements, 6-month redeterminations and restrictions on state use of revenues from provider taxes to help finance their share of Medicaid costs are estimated to result in the disenrollment of over 8 million people, 7.5 of whom will remain uninsured in 2034. Here is what the Q2 results tell us about where “Big Five” Medicaid enrollment currently stands.
As seen in Figure 1, the total Medicaid enrollment in all five companies has dropped in each quarter since the enactment of H.R. 1, from 36.2 million on June 30, 2025 to 34.0 million on June 30, 2026, a decline of 6.5 percent. (H.R. 1 was signed into law on July 4, 2025). This is directionally consistent with the decline in total Medicaid enrollment of 5.3 percent from 70.4 million in July 2025 to 66.7 million in April 2026, the most recent month for which CMS has posted data. (All company enrollment data are net of enrollment decreases and enrollment increases from all sources, including procurement wins or losses and mergers and acquisitions).
All of the Big Five experienced enrollment declines over the past four quarters, ranging from 2.6% for CVS Health/Aetna to 9.5 percent for UnitedHealth Group. (Table 1)
All of the Big Five except CVSHealth/Aetna report their Medicaid revenues. As shown in Table 2, Medicaid revenues increased between Q2 2025 and Q2 2026 for Centene, Elevance, and Molina and decreased slightly for UnitedHealth Group. Together, those four companies reported a total of $68.8 billion in Medicaid revenues for the quarter.
Management-Analyst Q&A
The enrollment declines described above are a prelude. Two of the H.R. 1 provisions driving the enrollment declines that account for the estimated reduction of $375 billion in federal Medicaid spending over the next ten years—work reporting requirements and 6-month redeterminations—are not federally mandated to be in effect until January 1, 2027. CBO expects that states will implement them gradually over the following two to three years. Researchers at the Urban Institute estimate that between 4.9 and 10.1 million people (between 27 and 55 percent of those subject to work reporting requirements) will be disenrolled by 2028, depending on states’ efforts to mitigate coverage loss. Manatt Health estimates that the Interim Final Rule, issued by CMS on June 1 to implement the work reporting requirements, will likely increase coverage losses beyond what would have occurred under a plain reading of the statute by an average of 1.8 million enrollees each year between FFY 2027-2034. Twenty-six states (including DC) have filed a lawsuit in federal court to block the implementation of parts of the IFR; a hearing is scheduled on October 20.
In short, there’s a lot of uncertainty as to how these and other H.R. 1 policies, including the limits on provider taxes that will undercut states’ abilities to finance their Medicaid programs, will play out. Perhaps in response to this uncertainty, one of the companies—Elevance Health—is starting to exit some Medicaid markets.
In her opening remarks at Elevance’s July 15 earnings call, CEO Gail Boureaux said:
We recently reached a mutual agreement with the District of Columbia to exit the DC Medicaid market. As we continue our assessment, we expect to exit additional Medicaid markets over the next 12-18 months where we do not see a path to sustainable performance. These are targeted portfolio actions and they do not change our commitment to serving Medicaid members in markets where we can deliver value for states, members, and shareholders.
In the Q&A, Lance Wilkes, a Senior Analyst at Bernstein Research asked:
…And maybe if you can just give a further clarification on the Medicaid exits—as far as criteria, are you looking at particular types of programs? Blue states? Or maybe your market share position in states that would be important criteria for determining which ones would be more likely to be subject to exit? Thanks.
Felicia Norwood, Elevance’s Chief Health Benefits Officer responded:
In terms of Medicaid exits, I will say that Medicaid remains, as Gail said, a very core part of our diversified portfolio. So, we’re going to be very disciplined around where we participate. We made a mutual decision with DC to exit. And we feel good about that decision and we will make sure that there is continuity of care for our members as we go through this transition. But as we take a look at our overall portfolio, we regularly assess all of the markets that we participate in. And as a result of this, we will plan to exit additional markets where the economics don’t support sustainable performance.
At the end of the day, Medicaid participation has to make strategic and financial sense for us within our diversified portfolio. So, where we have alignment with duals, our Carelon strategy, and a sustainable operating framework, we remain committed. And where those conditions aren’t present, we’re going to take the disciplined action that we need to. Bottom line, we are very committed to supporting members in states where we can deliver sustainable value going forward and we’ll continue to work very closely with our state partners.
In early July, Centene announced it would exit the Medicaid expansion program in Arkansas in 2027; a spokesperson reportedly said, “…with current funding challenges, we believe the program is not sustainable for our continued participation in 2027.” This development did not come up at its Q2 earnings call. Nor was the issue of Medicaid market exits raised in the CVS Health, Molina, or UnitedHealth earnings calls, either by management or the financial analysts. Time will tell whether Elevance is an outlier or a trendsetter.