Nearly 80 million Americans, including one in three children and half of all births, rely on Medicaid's vital safety net, a program now navigating a historic shift as pandemic protections unwind and record-high spending underscores its immense role in our nation's health.
Key Takeaways
- As of June 2024, total Medicaid/CHIP enrollment stood at 79,304,451 individuals across the U.S., reflecting a 0.5% decline from the previous month.
- In FY 2023, Medicaid enrollment averaged 81.8 million per month, a record high driven by pandemic-era continuous enrollment provisions.
- Children under 19 represent 37% of Medicaid enrollees, totaling approximately 29.5 million children in 2023.
- In FY 2023, total Medicaid spending reached $872 billion.
- Federal Medicaid spending in FY 2023 was $557.9 billion, 57% of total program costs.
- State Medicaid spending in FY 2023 totaled $314 billion.
- In FY 2023, 49% of U.S. population below poverty enrolled in Medicaid.
- Black Americans comprise 20% of Medicaid enrollees but 13% of U.S. population in 2022.
- Hispanics/Latinos make up 25% of Medicaid enrollees in 2023.
- Hospital utilization rate for Medicaid enrollees was 150 visits per 1,000 in 2022.
- Medicaid covers 100% of routine vaccines for children under CHIP.
- In 2022, 62% of Medicaid enrollees were in managed care plans.
- In 2014, 28 states plus DC adopted Medicaid expansion.
- 10 states remain non-expansion as of 2024, covering 2.3 million fewer adults.
- Expansion states have 15% lower uninsured rates for adults.
Medicaid enrollment remains near historic highs despite recent post-pandemic declines.
Enrollment and Coverage
- As of June 2024, total Medicaid/CHIP enrollment stood at 79,304,451 individuals across the U.S., reflecting a 0.5% decline from the previous month.
- In FY 2023, Medicaid enrollment averaged 81.8 million per month, a record high driven by pandemic-era continuous enrollment provisions.
- Children under 19 represent 37% of Medicaid enrollees, totaling approximately 29.5 million children in 2023.
- Medicaid expansion under the ACA covered 20.3 million adults in 36 states and DC as of 2024.
- During the COVID-19 unwinding period through June 2024, 25.1 million people were disenrolled from Medicaid nationwide.
- In 2022, Medicaid/CHIP covered 41% of all U.S. births, amounting to 1.8 million newborns.
- Elderly enrollees (65+) made up 11% of Medicaid population in 2021, about 8 million individuals.
- Working-age adults (19-64) without disabilities comprised 24% of enrollees in FY 2022, roughly 18 million.
- In 2023, Medicaid enrollment among non-elderly adults reached 32.5 million.
- Dual-eligible individuals (Medicare-Medicaid) numbered 12.3 million in 2022, 15% of total Medicaid enrollees.
- By December 2023, 40 states had completed 90% or more of Medicaid unwinding actions.
- Medicaid covered 50% of all U.S. children in low-income families in 2022.
- In FY 2021, average monthly Medicaid enrollment was 74.9 million.
- Expansion states saw Medicaid enrollment grow by 25% from 2013 to 2023.
- In 2024, Medicaid/CHIP enrollment in expansion states averaged 58 million.
- Non-expansion states had 22 million Medicaid enrollees in 2023.
- Medicaid enrollment peaked at 94 million in March 2023 due to continuous enrollment.
- By mid-2024, child enrollment in Medicaid/CHIP dropped 7% from pandemic highs.
- In 2022, 7.2 million people gained Medicaid coverage due to ACA expansion.
- Medicaid covers 93% of nursing home residents nationwide.
Enrollment and Coverage Interpretation
Despite setting a pandemic-era record of nearly 94 million enrollees—an anchor for a nation in crisis—the program is now experiencing the sobering postscript of 'unwinding,' where a drop in the total figure belies the immense and ongoing human stakes for the 1.8 million newborns it delivers, the 50% of low-income children it protects, and the 93% of nursing home residents it cares for.
Population Served
- In FY 2023, 49% of U.S. population below poverty enrolled in Medicaid.
- Black Americans comprise 20% of Medicaid enrollees but 13% of U.S. population in 2022.
- Hispanics/Latinos make up 25% of Medicaid enrollees in 2023.
- Women represent 58% of non-elderly adult Medicaid enrollees.
- 60% of Medicaid enrollees are from working families in 2022.
- Rural residents comprise 20% of Medicaid enrollees, higher than their 15% population share.
- People with disabilities account for 12% of enrollees but 40% of spending in 2021.
- Low-income children (under 200% FPL) are 95% of child Medicaid/CHIP enrollees.
- Pregnant women covered by Medicaid numbered 2.2 million annually pre-pandemic.
- SSI recipients automatically eligible for Medicaid total 7.5 million.
- Veterans represent 5% of Medicaid enrollees, about 4 million in 2022.
- Foster care children (under 19) are 100% eligible for Medicaid.
- In 2023, 28% of Medicaid enrollees were non-citizens or immigrants.
- Adults with behavioral health conditions comprise 25% of enrollees.
- Sickle cell disease patients: Medicaid covers 65% of them.
- In expansion states, 80% of new enrollees are working or recently worked.
- Medicaid enrollees aged 50-64 without Medicare: 6 million in 2022.
- American Indians/Alaska Natives: 28% enrolled in Medicaid.
- In 2022, Medicaid served 10 million people with HIV/AIDS.
- 75% of Medicaid spending for children goes to healthy kids under 6.
Population Served Interpretation
Medicaid, in its vital and sprawling way, is not just a safety net for the poor but a structural beam holding up America's working families, rural communities, veterans, children, and those facing illness and disability, revealing a program that catches an astonishing cross-section of the country where the private market and often luck have failed.
Spending and Financing
- In FY 2023, total Medicaid spending reached $872 billion.
- Federal Medicaid spending in FY 2023 was $557.9 billion, 57% of total program costs.
- State Medicaid spending in FY 2023 totaled $314 billion.
- Medicaid acute care spending per enrollee was $4,710 in FY 2022.
- Long-term services and supports (LTSS) accounted for 28% of Medicaid spending in 2021, or $211 billion.
- In 2022, Medicaid paid $98 billion for prescription drugs.
- Managed care organizations received 65% of Medicaid payments in 2023, totaling $565 billion.
- Fee-for-service spending dropped to 25% of total Medicaid expenditures in FY 2022.
- Per enrollee Medicaid spending grew 7.2% in 2022.
- Federal matching rate (FMAP) averaged 60% for states in FY 2023.
- Medicaid hospital spending was $202 billion in 2022, 24% of total.
- In FY 2023, Medicaid spending on children was $122 billion.
- Elderly LTSS spending comprised 47% of total LTSS costs in 2021.
- Expansion states' Medicaid spending increased by 40% from 2013-2022.
- Average state Medicaid budget was $10.5 billion in FY 2023.
- Pharmacy spending per enrollee rose 12% to $1,200 in 2022.
- Medicaid rebates from drug manufacturers totaled $58 billion in 2022.
- Capitation payments in managed care averaged $350 per member per month in 2023.
- In 2023, 42% of Medicaid spending was for working-age adults.
- Total Medicaid benefit spending grew 9.6% in FY 2022.
- Federal share of LTSS spending was 62% in 2021.
- States spent $45 billion on Medicaid administration in FY 2023.
- Medicaid physician spending per enrollee was $450 in 2022.
Spending and Financing Interpretation
The federal government foots the majority of the nearly $900 billion tab for Medicaid, a program whose managed-care dominated spending is growing briskly across states, driven significantly by the costly, essential long-term care for an aging population and prescription drugs for all.
State Variations and Expansion
- In 2014, 28 states plus DC adopted Medicaid expansion.
- 10 states remain non-expansion as of 2024, covering 2.3 million fewer adults.
- Expansion states have 15% lower uninsured rates for adults.
- Florida's Medicaid enrollment: 4.8 million in 2023.
- California's Medicaid (Medi-Cal) serves 15 million, 39% of population.
- FMAP rates vary: Mississippi 78%, New York 50% in FY2024.
- Texas non-expansion leaves 800,000 in coverage gap.
- New York spends $92 billion on Medicaid annually.
- 17 GOP-led states expanded post-2020, adding 4 million enrollees.
- Rural hospitals in expansion states: 50% less closure risk.
- Oklahoma's 2021 expansion added 600,000 enrollees.
- Per capita Medicaid spending highest in DC at $15,000.
- Missouri voters approved expansion in 2020, effective July 2021.
- Non-expansion states have 2.5x higher uninsured poor adults.
- Pennsylvania expansion saved $1 billion in state funds via taxes.
- Utah's partial expansion covers 150,000 via waiver.
- Georgia's Pathways waiver enrolled 500,000 by 2024.
- Expansion reduced state uncompensated care costs by 25%.
- North Carolina expanded in Dec 2023, projecting 600,000 new enrollees.
- Indiana's Healthy Indiana Plan has work requirements for 500,000.
- Waiver approvals: CMS approved 50 Section 1115 in 2023.
- South Dakota expansion in 2023 added 20,000 enrollees quickly.
State Variations and Expansion Interpretation
Here's a line that blends the impact of policy choices with a touch of wit: While the federal government picks up the tab for states to insure their poorest residents, a stubborn few are leaving billions on the table and their citizens in the lurch, proving that in health care, cutting off your nose to spite your face is both a political strategy and a public health crisis.
Utilization and Services
- Hospital utilization rate for Medicaid enrollees was 150 visits per 1,000 in 2022.
- Medicaid covers 100% of routine vaccines for children under CHIP.
- In 2022, 62% of Medicaid enrollees were in managed care plans.
- Emergency department visits by Medicaid patients: 45 million annually.
- Medicaid dental coverage utilization: 30% of adult enrollees in 2021.
- Home health services used by 10% of Medicaid LTSS enrollees.
- Behavioral health services: Medicaid covers 26% of U.S. spending.
- Opioid treatment: 40% of Medicaid enrollees with OUD receive medication-assisted treatment.
- Preventive services utilization: 70% of children get well-child visits.
- Nursing facility days: 8 million enrollees used 1.2 billion days in 2021.
- Telehealth visits in Medicaid surged 3,000% during pandemic peak.
- Prescription fills: 1.2 billion for Medicaid in 2022.
- Cancer screening rates: Medicaid women have 85% mammography rate.
- HCBS waiver slots: 700,000 people served in 2022.
- Inpatient hospital stays: Average 4.2 days for Medicaid patients.
- Mental health inpatient utilization: 12% of Medicaid psychiatric beds.
- Vision services: 50 states cover for children, 37 for adults.
- Hospice care: Medicaid pays for 40% of enrollees' end-of-life care.
- Primary care visits per enrollee: 4.5 annually in managed care.
- Maternal care: Medicaid prenatal care initiation within first trimester 85%.
Utilization and Services Interpretation
The statistics paint a portrait of Medicaid as a colossal, often stretched-thin, healthcare workhorse that administers immense preventative care—from ensuring most kids get their check-ups and vaccines to covering a quarter of the nation's behavioral health spending—while simultaneously struggling to get some adults to the dentist, racing to adapt via telehealth and managed care, and ultimately serving as a critical, if sometimes overburdened, safety net for millions in moments of acute crisis, chronic need, and dignified end-of-life care.
Sources & References
- Reference 1MEDICAIDmedicaid.govVisit source
- Reference 2CMScms.govVisit source
- Reference 3KFFkff.orgVisit source
- Reference 4CBPPcbpp.orgVisit source
- Reference 5MACPACmacpac.govVisit source
- Reference 6HEALTHAFFAIRShealthaffairs.orgVisit source
- Reference 7NASBOnasbo.orgVisit source
- Reference 8HEALTHMANAGEMENThealthmanagement.comVisit source
- Reference 9AHAaha.orgVisit source
- Reference 10GAOgao.govVisit source
- Reference 11RURALHEALTHINFOruralhealthinfo.orgVisit source
- Reference 12SSAssa.govVisit source
- Reference 13VAva.govVisit source
- Reference 14SAMHSAsamhsa.govVisit source
- Reference 15CDCcdc.govVisit source
- Reference 16HCUP-UShcup-us.ahrq.govVisit source
- Reference 17MCHBmchb.hrsa.govVisit source
- Reference 18NAMInami.orgVisit source
- Reference 19MEDPACmedpac.govVisit source
- Reference 20COMMONWEALTHFUNDcommonwealthfund.orgVisit source
- Reference 21AHCAahca.myflorida.comVisit source
- Reference 22DHCSdhcs.ca.govVisit source
- Reference 23HEALTHhealth.ny.govVisit source
- Reference 24SHEPSCENTERshepscenter.unc.eduVisit source
- Reference 25OKLAHOMAoklahoma.govVisit source