Regulation
Medicaid enrollment falls 5.1 million in a year as new work rules loom
By Insurance Wire Staff, . Insurance Wire.
Medicaid enrollment has been falling steadily for more than a year, and the latest federal data show the pace has not slowed. As of July 2026, roughly 72.9 million people were enrolled in Medicaid and the Children's Health Insurance Program combined, a drop of 5.1 million, or 7 percent, from July 2025, according to KFF, which tracks monthly figures published by the Centers for Medicare & Medicaid Services.
Medicaid is the joint federal-state program that provides health coverage to low-income adults, children, pregnant women, elderly adults and people with disabilities. CHIP covers children in families that earn too much to qualify for Medicaid but too little to afford private insurance.
How far enrollment has fallen
Of the 72.9 million total, 65.7 million were enrolled in Medicaid and 7.2 million in CHIP. The decline was nearly universal: 49 states and D.C. recorded lower total enrollment compared with July 2025. The range was wide. Iowa posted a 1 percent increase, while Indiana saw an 18 percent decrease, the steepest in the country.
Child enrollment fell in 49 states and D.C. over the same period. Adult enrollment dropped in all but five states: Iowa, Missouri, North Carolina, Oklahoma and South Dakota. CHIP enrollment, by contrast, rose in 17 states, including California, Florida, Illinois and North Carolina.
For context, total Medicaid and CHIP enrollment is still about 2 percent higher than it was in February 2020, before the pandemic drove a surge in enrollment. But children have not recovered their pre-pandemic footing: in the 49 states with complete age-group data, child enrollment was down by 1,110,000, or 3 percent, compared with February 2020.
The July 2026 figures are preliminary and may be revised in later reports. Rhode Island did not report data for December 2024 because of a technical problem, and Arizona is excluded from the national age-group totals because the state did not report enrollment by age before May 2024.
What the 2025 reconciliation law adds
The enrollment decline so far has been driven largely by the unwinding of pandemic-era continuous enrollment protections, which required states to keep people enrolled regardless of changes in their circumstances. That process has been running for more than a year.
A new pressure is now on the horizon. The 2025 federal reconciliation law requires adults in the Medicaid expansion group, which covers low-income adults up to 138 percent of the federal poverty level, and adults in certain Section 1115 waiver programs to satisfy new work and community engagement requirements. Those requirements are set to take effect in January 2027. The law is expected to reduce Medicaid enrollment over the next decade relative to what enrollment would have been under prior law, according to the KFF tracker.
Section 1115 waivers allow states to test alternative approaches to Medicaid delivery and eligibility under federal approval.
What carriers, brokers and states should watch
For insurers that hold Medicaid managed care contracts, a continued enrollment decline means lower premium revenue from state Medicaid agencies. The scale of the drop varies enough by state that carriers with concentrated exposure in high-decline states such as Indiana face a materially different outlook than those in states where enrollment has held steadier.
Brokers and navigators who help people find coverage should expect increased demand from adults losing Medicaid eligibility under the new work requirements, particularly in expansion states. Whether those individuals shift to marketplace plans, employer coverage or become uninsured will depend heavily on how states implement the requirements and what outreach infrastructure is in place.
The data do not yet capture any effect from the January 2027 work requirement deadline. The months immediately following that date will be the first real test of how large the additional enrollment reduction will be.
Source: https://www.kff.org/medicaid/medicaid-enrollment-tracker/
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