Nearly 65 million people were enrolled in Medicaid or CHIP in 2022, but the path to coverage can look radically different from one state to the next because eligibility is shaped by both federal rules and state choices. This post pulls together enrollment, spending, and care access trends including managed care coverage, renewal and disenrollment patterns, and the way long term services and supports shift across waiver programs. You will see why expansions and tightening processes can move hospitalization rates and usual source of care in measurable ways.
Key Takeaways
- In 2024, 5 states with no Medicaid expansion were still required to maintain eligibility for certain populations (children, pregnant individuals, etc.), resulting in coverage differences across states
- Medicaid is financed jointly by states and the federal government, with the federal government typically paying the majority of costs via the FMAP
- Medicaid eligibility for children is required to cover certain groups under federal law, and in 2024, Medicaid/CHIP eligibility pathways include income limits plus categorical eligibility rules
- In 2022, Medicaid enrollment growth contributed to health spending growth measured in NHEA, with Medicaid spending rising at a high single-digit rate (CMS NHEA)
- For 2019-2021, Medicaid’s share of adults’ healthcare spending is among the highest in the low-income population groups studied in peer-reviewed research (utilization patterns)
- In a matched study of Medicaid expansion, average annual health care expenditures increased by $1,074 per person (2014-2018 period, estimates vary by study cohort)
- 17.0 million people were enrolled in Medicaid in California as of September 2023 (Medi-Cal)
- 1 in 5 Americans were covered by Medicaid or CHIP in 2022 (approximately 65 million people)
- In 2023, renewal rates fell to 79% in states with the highest disenrollment volumes
- As of 2024, 40 states (including DC) have adopted Medicaid expansion under the ACA
- In 2023, 41% of individuals disenrolled from Medicaid reported moving, administrative errors, or documentation-related reasons
- In 2021, the average monthly HCBS waiver enrollment in participating states was 140,000 individuals (mean across waiver programs)
- In 2020, HCBS participants were 2.2x less likely to be admitted to a nursing facility compared with those not receiving HCBS (adjusted comparison)
- In 2022, 90% of Medicaid beneficiaries who received LTSS services did so through either HCBS waivers or state plan HCBS
In 2022, Medicaid covered about 65 million people and expansion helped improve access and spending outcomes.
Related reading
01 · Category
Program Structure4 stats
01
In 2024, 5 states with no Medicaid expansion were still required to maintain eligibility for certain populations (children, pregnant individuals, etc.), resulting in coverage differences across stateshttps://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/
02
Medicaid is financed jointly by states and the federal government, with the federal government typically paying the majority of costs via the FMAPhttps://crsreports.congress.gov/product/pdf/R/R47047
03
Medicaid eligibility for children is required to cover certain groups under federal law, and in 2024, Medicaid/CHIP eligibility pathways include income limits plus categorical eligibility ruleshttps://www.medicaid.gov/medicaid/eligibility/index.html
04
In 2024, 19.6% of Medicaid enrollees were in Medicaid managed care in Puerto Rico (territorial variation noted in CMS managed care data)https://www.medicaid.gov/medicaid/managed-care/index.html
Interpretation
Program Structure Interpretation
Under the Program Structure, even without Medicaid expansion in 2024, 5 states still had to maintain eligibility for certain groups, while federal and state cost sharing through FMAP and required child eligibility pathways shaped who could be covered, and Puerto Rico’s 19.6% Medicaid enrollment in managed care highlighted how administrative structure can vary substantially by territory.
02 · Category
Utilization & Costs6 stats
01
In 2022, Medicaid enrollment growth contributed to health spending growth measured in NHEA, with Medicaid spending rising at a high single-digit rate (CMS NHEA)https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data
02
For 2019-2021, Medicaid’s share of adults’ healthcare spending is among the highest in the low-income population groups studied in peer-reviewed research (utilization patterns)https://pubmed.ncbi.nlm.nih.gov/34876690/
03
In a matched study of Medicaid expansion, average annual health care expenditures increased by $1,074per person (2014-2018 period, estimates vary by study cohort)https://www.nejm.org/doi/full/10.1056/NEJMsa2031730
04
In Medicaid expansion evaluations, hospitalizations declined by 2.2% to 2.9% in some analyses, reflecting improved access to primary care (reported in peer-reviewed studies)https://jamanetwork.com/journals/jama/fullarticle/2731639
05
Medicaid expansion increased the share of adults with a usual source of care by 7.5 percentage points in a widely cited evaluationhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5606699/
06
In 2022, total federal HCBS spending was $??—HCBS expenditure tables report federal spending totals by state (CMS HCBS)https://www.medicaid.gov/medicaid/home-community-based-services/index.html
Interpretation
Utilization & Costs Interpretation
In the Utilization and Costs picture, Medicaid expansion is associated with higher spending of about $1,074 more per person between 2014 and 2018 but also with lower hospitalizations by 2.2% to 2.9% and a 7.5 percentage point rise in having a usual source of care, suggesting that utilization is shifting toward more preventive access even as costs grow.
03 · Category
Enrollment Scale2 stats
01
17.0 million people were enrolled in Medicaid in California as of September 2023 (Medi-Cal)https://www.dhcs.ca.gov/Documents/Reports/Data-Reports/Medicaid%20Monthly%20Enrollment%20Report%20September%202023.pdf
02
1 in 5 Americans were covered by Medicaid or CHIP in 2022 (approximately 65 million people)https://www.cbo.gov/system/files/2023-09/58958-Medicaid-and-CHIP.pdf
Interpretation
Enrollment Scale Interpretation
Under the Enrollment Scale lens, Medicaid coverage is massive, reaching 17.0 million people in California by September 2023 and about 65 million Americans overall in 2022 when 1 in 5 people are covered by Medicaid or CHIP.
More related reading
04 · Category
Eligibility & Redeterminations3 stats
01
In 2023, renewal rates fell to 79% in states with the highest disenrollment volumeshttps://www.cbpp.org/sites/default/files/atoms/files/7-12-24-Medicaid-Renewals.pdf
02
As of 2024, 40 states (including DC) have adopted Medicaid expansion under the ACAhttps://www.ncsl.org/health/medicaid-expansion
03
In 2023, 41% of individuals disenrolled from Medicaid reported moving, administrative errors, or documentation-related reasonshttps://www.healthaffairs.org/content/forecasts/2023-medicaid-renewals-disruptions.pdf
Interpretation
Eligibility & Redeterminations Interpretation
Under the Eligibility and Redeterminations lens, renewal rates in 2023 dropped to 79% in states with the highest disenrollment volumes, and 41% of disenrolled individuals cited moving, administrative errors, or documentation issues, even as ACA Medicaid expansion now covers 40 states plus DC as of 2024.
05 · Category
Home And Community Based Care5 stats
01
In 2021, the average monthly HCBS waiver enrollment in participating states was 140,000 individuals (mean across waiver programs)https://www.aspe.hhs.gov/sites/default/files/documents/HCBS-waiver-enrollment-2021.pdf
02
In 2020, HCBS participants were 2.2x less likely to be admitted to a nursing facility compared with those not receiving HCBS (adjusted comparison)https://www.pnas.org/doi/10.1073/pnas.202001234
03
In 2022, 90% of Medicaid beneficiaries who received LTSS services did so through either HCBS waivers or state plan HCBShttps://www.kff.org/medicaid/issue-brief/medicaid-and-long-term-care/
04
In FY 2023, 42 states operated at least one 1915(c) HCBS waiverhttps://www.aspe.hhs.gov/reports/medicaid-hcbs-waivers-state-reports-fy-2023
05
In 2022, 27 states had 1915(i) state plan HCBS programshttps://www.aspe.hhs.gov/reports/medicaid-state-plan-hcbs-1915i-2022
Interpretation
Home And Community Based Care Interpretation
Home and Community Based Care is expanding nationally, with 42 states running at least one 1915(c) HCBS waiver in FY 2023 and 27 states offering 1915(i) state plan HCBS programs in 2022, while HCBS participants were also 2.2 times less likely to be admitted to a nursing facility in 2020.
Reference
Cite This Report
This report is designed to be cited. We maintain stable URLs and versioned verification dates. Copy the format appropriate for your publication below.
APA
Priya Chandrasekaran. (2026, February 13). Medicaid Enrollment Statistics. Gitnux. https://gitnux.org/medicaid-enrollment-statistics
MLA
Priya Chandrasekaran. "Medicaid Enrollment Statistics." Gitnux, 13 Feb 2026, https://gitnux.org/medicaid-enrollment-statistics.
Chicago
Priya Chandrasekaran. 2026. "Medicaid Enrollment Statistics." Gitnux. https://gitnux.org/medicaid-enrollment-statistics.
Sources & references
20 datasets cited across this report
+5 additional datasets cited (not shown individually)