This tracker presents the most recent data on monthly Medicaid and Children’s Health Insurance Program (CHIP) enrollment reported by the Centers for Medicare & Medicaid Services (CMS) as part of the Performance Indicator Project. It includes data for Medicaid and CHIP and reports enrollment data for children and adults. The data are generally the most recent data available and are useful for reporting trends in Medicaid enrollment. However, the data only capture full-benefit enrollees, excluding those who receive limited benefits, such as those who receive family planning services only, and consequently, do not provide a full count of the total population enrolled in Medicaid. Additionally, these data cannot be used to monitor changes in enrollment by eligibility pathway, including for adults in the Medicaid expansion group.

The 2025 reconciliation law included significant changes to Medicaid, including requiring adults in the expansion group and in certain 1115 waiver programs to meet new work and reporting requirements starting January 2027. These changes are expected to reduce Medicaid enrollment over the next 10 years relative to what would have been expected under current law. Enrollment data for the full Medicaid population is available here, and for more information on how implementation of Medicaid work requirements is affecting Medicaid expansion enrollment, please see Tracking Implementation of the 2025 Reconciliation Law Medicaid Work Requirements.

Medicaid/CHIP Historical Enrollment Trends

Medicaid/CHIP Current Enrollment Trends

The figures below show Medicaid and CHIP enrollment from February 2020 through the most current month of available data. Figures include enrollment for adults and children in Medicaid/CHIP and for Medicaid only and CHIP only. Key enrollment data and trends as of May 2026 include:

• There were 73.5 million people enrolled in Medicaid/CHIP nationally (Figure 1). Medicaid enrollment declined by 5 million or 6% from May 2025 through May 2026 (Table 1).
• Total Medicaid/CHIP enrollment has decreased in 49 states and DC since May 2025. Enrollment changes since May 2025 vary from a less than 1% increase in Iowa to a 20% decrease in Indiana (Figure 2).
• Child enrollment in Medicaid/CHIP has decreased in 49 states and DC from May 2025 through May 2026. Adult enrollment has decreased in all but five states (IA, MO, NC, OK, SD) (Figure 2).
• There were 66.4 million people enrolled in Medicaid and 7.1 million people enrolled in CHIP (Figure 1). Since May 2025, Medicaid enrollment has decreased in 49 states and DC while CHIP enrollment has increased in 21 states (AL, CA, CT, DE, FL, HI, IL, MO, NE, NJ, NM, NC, ND, OK, RI, SC, TN, VT, WA, WI, WY).
• Total Medicaid/CHIP enrollment was 3% higher in May 2026 compared to enrollment in February 2020, prior to the pandemic. However, in the 49 states and DC with complete enrollment data by age, the number of children enrolled in Medicaid/CHIP declined by 789,000 or 2% from February 2020 to May 2026 (Figure 2 and Table 1).

Note: The data on unwinding renewal outcomes presented below were last updated on September 12, 2024; since most states have now completed the Medicaid unwinding, the information will not be updated again.

As of September 12, 2024 and with nearly complete unwinding data for most states: 

• Over 25 million people were disenrolled (31% of completed renewals) and over 56 million people had their coverage renewed (69% of completed renewals).  
• Disenrollment rates varied across states from 57% in Montana to 12% in North Carolina, driven by a variety of factors including differences in renewal policies and procedures as well as eligibility expansions in some states.  
• Among those who were disenrolled, nearly seven in ten (69%) were disenrolled for paperwork or procedural reasons while three in ten (31%) were determined ineligible.  
• Among those whose coverage was renewed during the unwinding, 61% were renewed on an ex parte, or automated, basis, meaning the individual did not have to take any action to maintain coverage. 

State Data on Renewal Outcomes

The data on unwinding-related renewal outcomes presented in this section rely primarily on monthly reports that states were required to submit to the Centers for Medicare & Medicaid Services (CMS) during the unwinding period. The data also reflect updates to the monthly reports that states submit three months after the original report submission to account for the resolution of pending cases and any other changes in renewal metrics. For 13 states, data were pulled from dashboards or reports published on state websites that provide more complete information, and for a few additional states, updated monthly reports were pulled from state websites because they were more timely than what is reported on the CMS website. 

To view archived data for specific states, click on the State Data - Archived tab.

Medicaid Disenrollments

• As of September 12, 2024, at least 25,198,000 Medicaid enrollees had been disenrolled during the unwinding of the continuous enrollment provision. Overall, 31% of people with a completed renewal were disenrolled in reporting states while 69%, or 56.4 million enrollees, had their coverage renewed.
• There is wide variation in disenrollment rates across reporting states, ranging from 57% in Montana to 12% in North Carolina. A variety of factors contribute to these differences, including differences in renewal policies and system capacity. Some states adopted policies that promote continued coverage among those who remain eligible and/or have automated eligibility systems that can more easily and accurately process renewals while other states have adopted fewer of these policies and have more manually-driven systems. In addition, North Carolina and South Dakota adopted Medicaid expansion and other states increased eligibility levels for certain populations (e.g., children, parents, etc.) during the unwinding, which may have lowered disenrollment rates in these states.

• Across all states with available data, 69% of all people disenrolled had their coverage terminated for procedural reasons. However, these rates vary based on how they are calculated (see note below). Procedural disenrollments are cases where people are disenrolled because they did not complete the renewal process and can occur when the state has outdated contact information or because the enrollee does not understand or otherwise does not complete renewal packets within a specific timeframe. High procedural disenrollment rates are concerning because many people who are disenrolled for these paperwork reasons may still be eligible for Medicaid coverage. 

(Note: The first tab in the figure below calculates procedural disenrollment rates using total disenrollments as the denominator. The second tab shows these rates using total completed renewals, which include people whose coverage was terminated as well as those whose coverage was renewed, as the denominator. And finally, the third tab calculates the rates as a share of all renewals due, which include completed renewals and pending cases.)

Medicaid Renewals

• Of the people whose coverage has been renewed as of September 12, 2024, 61% were renewed on an ex parte basis while 39% were renewed through a renewal form, though rates vary across states. Under federal rules, states are required to first try to complete administrative (or “ex parte”) renewals by verifying ongoing eligibility through available data sources, such as state wage databases, before sending a renewal form or requesting documentation from an enrollee. Ex parte renewal rates varied across states from 90% or more in Arizona, North Carolina, and Rhode Island to less than 20% in Pennsylvania and Texas. 

Federal Data on Renewal Outcomes

The data presented here are cumulative unwinding metrics published by CMS. These counts and percentages may differ from the above data, which present renewal metrics reported on state websites when state-reported data are more complete.  

Figure 1 below shows cumulative renewal data reported by CMS during states’ unwinding periods. Renewal data for the months after the end of states’ unwinding period are excluded. The data reflect updated unwinding data reported by states three months after the original monthly reports as they become available.   

For questions about this tracker, please contact KFFTracker@kff.org

Note: The state data presented below were last updated on September 12, 2024; since most states have now completed the Medicaid unwinding, the information will not be updated again. 

The data presented here provide state-level data on enrollment trends and renewal outcomes during the unwinding period. Figure 1 shows total Medicaid enrollment by month starting in January 2023 and, once disenrollments resumed in a state, the cumulative percent change in Medicaid enrollment relative to the month before Medicaid disenrollments started (this baseline month will differ across states). Figure 2 shows renewal metrics for each month of a state’s unwinding period (or cumulative data for the unwinding period for some states). 

For total national Medicaid enrollment, click on the Enrollment Data tab.

Resources on unwinding data

• An Examination of Medicaid Renewal Outcomes and Enrollment Changes at the End of the Unwinding
• How Did Medicaid Renewal Outcomes Change During the Unwinding?
• KFF Survey of Medicaid Unwinding
• Three Questions About Medicaid Unwinding: What We Know and What to Expect
• Halfway Through the Medicaid Unwinding: What Do the Data Show?
• Unwinding of Medicaid Continuous Enrollment: Key Themes from the Field
• Navigating the Unwinding of Medicaid Continuous Enrollment: A Look at Enrollees Experiences
• Six Months into the Medicaid Unwinding: What Do the Data Show and What Questions Remain?
• What Do Medicaid Unwinding Data by Race and Ethnicity Show?
• Understanding Medicaid Ex Parte Renewals During the Unwinding
• States Obtain Special Waivers to Help Unwinding Efforts
• Understanding Medicaid Procedural Disenrollment Rates
• Do State Decisions to Prioritize Renewals for Medicaid Enrollees Who are Likely Ineligible Affect Early Disenrollment Rates?
• What Do the Early Medicaid Unwinding Data Tell Us?
• How Many People Might Lose Medicaid When States Unwind Continuous Enrollment?

Resources on state policies and preparations for the unwinding

• A Look at Medicaid and CHIP Eligibility, Enrollment, and Renewal Policies During the Unwinding of Continuous Enrollment and Beyond
• State Policy Choices Are Likely to Affect the Extent of Medicaid Enrollment Declines During the Unwinding Period
• Medicaid and CHIP Eligibility, Enrollment, and Renewal Policies as States Prepare for the Unwinding of the Pandemic-Era Continuous Enrollment Provision
• The Unwinding of Medicaid Continuous Enrollment: Knowledge and Experiences of Enrollees
• Unwinding the Continuous Enrollment Provision: Perspectives from Current Medicaid Enrollees

Resources on pre-pandemic enrollment patterns and coverage transitions

• What Happens After People Lose Medicaid Coverage?
• Medicaid Enrollment Growth: Estimates by State and Eligibility Group Show Who may be at Risk as Continuous Enrollment Ends
• Unwinding the PHE: What We Can Learn From Pre-Pandemic Enrollment Patterns
• Medicaid Enrollment Churn and Implications for Continuous Coverage Policies
• Implications of Continuous Eligibility Policies for Children’s Medicaid Enrollment Churn
• Medicaid Enrollment Patterns During the Postpartum Year

KFF’s unwinding explainer

• 10 Things to Know About the Unwinding of the Medicaid Continuous Enrollment Provision

Key Takeaways

• LGBTQ+ adults face significantly greater challenges accessing and affording health care compared to their non-LGBTQ+ peers. They are more likely to postpone or skip needed care (58% vs. 38%), forgo prescription medications due to cost (22% vs. 12%), and struggle to pay medical bills (30% vs. 21%).
• Cost-related barriers to care are especially pronounced among certain segments of the LGBTQ+ population, most notably trans adults, younger LGBTQ+ adults, those with lower incomes, and those without health coverage. Eight in ten (82%) trans adults, three-quarters (77%) of LGBTQ+ adults without health coverage, and two-thirds (68%) of those under age 30 report not getting needed health care in the past 12 months either because they couldn’t get an appointment, couldn’t afford the cost, or for another reason. Additionally, larger shares of LGBQ+ women than men report skipping or delaying care in the past year (63% vs. 46%).
• While trans adults represent a small share of the total LGBTQ+ population, they experience outsized barriers to affording care and other access issues. Compared with other LGBQ+ groups, trans adults report the highest rates of difficulty finding providers with available appointments (53%), not taking prescription medications because of cost (39%), worsening health from postponed care (45%), struggling with medical bills (42%), and experiencing insurance delays or denials (61%). Trans adults experience these greater barriers to health cost and access even when controlling for other demographic variables such as age, income, and insurance status.
• Health care costs create significant financial strain for many LGBTQ+ adults. Three in ten (30%) report problems paying medical bills in the past year, and one in five (19%) say they cut back on household necessities such as food or clothing to pay for health care costs. Financial burdens are particularly common among younger adults, those with lower incomes, and those without health coverage.
• Having health insurance does not guarantee timely access to care. About three in ten LGBTQ+ insured adults report that their insurance delayed or denied coverage for recommended care in the past two years, a more widespread experience than among non-LGBTQ+ insured adults, with particularly high rates among trans adults and those covered by Medicaid or those with ACA marketplace coverage.

Understanding the Challenges LGBTQ+ Adults Face Affording Health Care

LGBTQ+ adults in the U.S. are a growing population who have historically faced health disparities in terms of both wellbeing and health care access and affordability. Previous research has found that LGBTQ+ adults are more likely than their non-LGBTQ+ peers to experience barriers to obtaining needed care, to struggle to afford health care costs, and to delay or forgo care because of cost. These affordability challenges often intersect with and may even be a driver of broader health disparities, including poorer mental and physical health outcomes, particularly among trans adults.

Understanding the financial challenges LGBTQ+ adults face when accessing health care can help identify persistent gaps in affordability and inform efforts to improve access to needed care and coverage.

Delays in Health Care for LGBTQ+ Adults

Six in ten LGBTQ+ adults (58%) say they have skipped or postponed needed health care in the past year, greater shares than their non-LGBTQ+ counterparts (38%). This includes more than four in ten (43%) LGBTQ+ adults who say they’ve skipped or delayed getting needed care because of the cost and about three in ten who said it was due to their inability to get an appointment (28%) or for some other reason (29%). LGBTQ+ adults are nearly twice as likely as non-LGBTQ+ adults (26%) to say they’ve skipped or delayed getting needed care because of the costs.

Compared to other LGBQ+ adults, trans adults are more likely to report they have put off care in the past year because of cost or other issues (82%). At least half of trans adults say they skipped or postponed getting needed health care because of the cost (56%), because they couldn’t find a doctor or health care provider with appointments available (53%), or they skipped or postponed for any other reasons (48%). There may be many reasons why trans adults are more likely to skip or delay care, but a recent KFF/Washington Post Trans Survey found significant barriers for trans adults in getting needed health care, including providers not being properly educated to provide appropriate care.

Beyond trans adults, larger shares of LGBQ+ women than men report skipping or postponing care in the past year (63% vs. 46%). This includes half of LGBQ+ women who say they skipped or postponed needed care because of the cost (compared to a third of LGBQ+ men), and roughly a third of LGBQ+ women who say they skipped or postponed care because they couldn’t get an appointment (31% vs. 19% of LGBQ+ men) or for any reason besides cost or not being able to get an appointment (32% vs. 21% of LGBQ+ men). Across all LGBTQ+ groups, non-LGBTQ+ adults less commonly reported skipping or postponing care.  

Many socioeconomic and demographic factors can predict delaying or skipping care, but LGBTQ+ adults are more likely to skip or delay care even when controlling for race and ethnicity, insurance coverage, age, income, and education, suggesting this population group may have unique struggles in accessing needed health care. The differences reported in this analysis between LGBTQ+ adults and non-LGBTQ+ adults hold even when controlling for these demographic characteristics.

Among all LGBTQ+ adults, two-thirds (68%) of those under age 30 report having put off needed care in the past year, higher than the shares of older LGBTQ+ adults who report this. While age is a significant predictor of putting off care regardless of sexual identity, LGBTQ+ adults under age 30 are twenty percentage points more likely to report putting off care than non-LGBTQ+ adults in the same age range (48%). In fact, across most age groups, LGBTQ+ adults are more likely to report putting off or postponing needed care than their non-LGBTQ+ counterparts, except for those 65 and older. The difference between LGBTQ+ and non-LGBTQ+ adults levels out among those age 65 and older, which may be due to several factors, such as increased medical care among older adults and Medicare eligibility.

Insurance and income also play a role in accessing care. Three in four (77%) LGBTQ+ adults without health insurance report having missed or delayed care in the past year for any reason, compared to six in ten LGBTQ+ adults with health insurance. Fewer non-LGBTQ+ adults than LGBTQ+ adults without health insurance report experiencing any of the following in the past year (65% vs. 77% of uninsured LGBTQ+ adults).

Similarly, about six in ten LGBTQ+ adults with household incomes under $40,000 a year (59%) or between $40,000 and $99,999 a year (63%) say they skipped or postponed needed care, compared to half of those with annual incomes of $100,000 or more. Even among the highest income groups or those with health insurance, LGBTQ+ adults are more likely than non-LGBTQ+ adults to say they skipped or delayed needed care in the past year.

Substantial shares of LGBTQ+ adults report postponing their care worsened their health, and that number is especially pronounced among trans adults. Three in ten (29%) LGBTQ+ adults say their health got worse because they skipped or delayed care, which is about twice the share of non-LGBTQ+ adults who report the same (14%). This experience is more common among LGBQ+ women (34%) than LGBQ+ men (20%). Almost half (45%) of trans adults say they delayed or skipped care and their health got worse as a result.

The share who say their health got worse due to postponing care also rises to roughly a third of uninsured LGBTQ+ adults (35%) and those under age 30 (35%). One-third (33%) of LGBTQ+ adults with household incomes of less than $40,000 report that their health got worse because of postponed care.

Impacts of Cost on Prescription Medications

Cost barriers also affect prescription medication behavior, including among LGBTQ+ adults, with about a fifth of LGBTQ+ adults (22%) saying they’ve cut pills in half, skipped doses of a medication, or decided not to fill a prescription because they couldn’t afford the cost (compared to 12% of non-LGBTQ+ adults). Trans adults (39%), LGBTQ+ adults without insurance (28%), LGBQ+ women (25%), and younger LGBTQ+ adults (23% of those under age 30), are the most likely to report that they didn’t take their prescription medication as prescribed due to cost.

In addition, around a quarter of LGBTQ+ adults with lower incomes report cutting pills in half, skipping doses of medications, or not filling a prescription in the past year due to cost, including 27% of those with a household income of less than $40,000 a year, and 24% of those with incomes between $40,000 and $99,999 a year, compared to around one in ten (12%) of LGBTQ+ adults with incomes of $100,000 or more a year.

Difficulty Paying Medical Bills

Substantial shares of LGBTQ+ adults also report struggling with medical bills. Three in ten LGBTQ+ adults say they have had problems paying for or were unable to pay a medical bill, including bills for doctors, tests or labs, or medication in the past 12 months, higher than the 21% of non-LGBTQ+ adults who say the same. This includes four in ten (42%) trans adults, over a third (36%) of LGBQ+ women and two in ten (21%) LGBQ+ men.

Problems with bills can lead to important financial consequences for many LGBTQ+ adults. Two in ten (19%) LGBTQ+ adults, including two in ten (22%) LGBQ+ women and roughly one in ten (13%) LGBQ+ men say they’ve had to cut back on household expenses like food, clothing, or other basic household items in order to pay for health care costs. This experience is more common among trans adults, over one quarter of whom (28%) report the same. Overall, LGBTQ+ adults report they have cut back on necessities to pay for health care costs more commonly than non-LGBTQ+ adults (13%).

Younger LGBTQ+ adults and those with lower household incomes, two groups with considerable overlap, are among the most likely to report problems paying medical bills in the past year, with around a third of those under age 30 (33%), between 30 and 49 (34%), those with incomes of less than $40,000 a year (35%) or between $40,000 and $99,999 (35%) reporting they had problems paying or an inability to pay for any medical bills in the past year. Individuals earning over $100,000 annually and those 65 and older, who are largely covered by Medicare, are less likely to report such problems.

Younger LGBTQ+ adults and those with lower incomes are also more likely to report cutting back on expenses because of their problems paying medical bills. Overall, a quarter (24%) of LGBTQ+ adults with household incomes less than $40,000 a year say they have cut back on household expenses like food, clothing or other basic household items to pay for health care costs, compared to two in ten (19%) LGBTQ+ adults with incomes between $40,000 and $99,999 and one in ten (11%) of those with incomes of $100,000 or more a year.

Younger LGBTQ+ adults are also more likely to report cutting back on expenses because of trouble paying medical bills, including two in ten LGBTQ+ adults under age 30 and between ages 30 to 49 (21% for each) compared to one in ten (13%) LGBTQ+ adults ages 50 to 64 and one in twelve (8%) of those ages 65 and older.

Insurance Delays or Denials

Treatments or medications recommended by a provider may be delayed, and in some cases, an insurance company may deny coverage for the recommended medication or treatment after or during the care process. While insurance coverage helps some LGBTQ+ adults deal with access and cost issues, many face other challenges such as delayed or denied care.

Roughly one-third of insured LGBTQ+ adults say their insurance company denied coverage (32%) or delayed (30%) their ability to get a health care service, treatment, or medication that their doctor prescribed in the past two years. Four in ten say coverage has either been delayed or denied. These shares are substantially higher than among non-LGBTQ+ adults, about a quarter (26%) of whom say they’ve experienced a denial of service (21%) or delay (17%) in the past two years.

These experiences are particularly common among trans adults, roughly six in ten (61%) of whom say they’ve been delayed (53%) or denied (45%) coverage by their insurance for a service, treatment, or medication prescribed by their doctor in the past two years.

Delays and denials of coverage for LGBTQ+ adults vary based on what type of insurance they have. Individuals with either self-purchased plans or Medicaid report experiencing these most often. Roughly half (48%) of LGBTQ+ adults under age 65 who have Medicaid (48%) or self-purchased insurance (46%) say their insurance company has denied or delayed health care services, treatments, or medications in the past two years. Given that Medicaid plays a larger role in covering LGBTQ+ people, this coverage difference may in partially explain some of the disparate challenges this group faces with delays and denials.  

Roughly four in ten (39%) LGBTQ+ adults under age 65 with employer-sponsored insurance say the same while just three in ten (28%) LGBTQ+ adults ages 65 and older with Medicare report experiencing recent delays and denials.

The share of LGBTQ+ adults with various types of health insurance who report delays or denials of needed care is larger than the share of non-LGBTQ+ adults who say the same. Roughly a third of those non-LGBTQ+ adults with Medicaid (33%) or self-purchased insurance (31%), around a quarter (26%) of those with employer-sponsored coverage, and around two in ten (18%) of non-LGBTQ+ adults who have Medicare and are ages 65 or older report these issues.

The KFF Survey of Health Status and Caregiving was a series of questions designed and implemented by KFF with the SSRS Opinion Panel Mega-Omnibus. The survey was conducted May 4 – May 26, 2026, online and by telephone among a nationally representative sample of 25,873 U.S. adults in English (n=25,422) and in Spanish (n=451).

The SSRS Opinion Panel is a nationally representative probability-based panel where panel members are recruited randomly in one of two ways: (a) Through invitations mailed to respondents randomly sampled from an Address-Based Sample (ABS) through the U.S. Postal Service’s Computerized Delivery Sequence (CDS); (b) recruited via random digit dial (RDD) telephone sample of cell phone numbers connected to a prepaid cell phone. Both samples were provided by Marketing Systems Group (MSG). The combined sample was reached either online (n=24,875) or over the phone (n=998) based on the panelist’s stated preference. For the online panel component, invitations were sent to panel members by email followed by up to four reminder emails and up to two reminder text messages (if consented to receive SMS).

The questions designed by KFF were included as part of a multi-stakeholder effort designed to survey all individuals currently empaneled in the SSRS Opinion Panel, with each organization paying for and having independent editorial control over its survey questions.  Substantive questions from other outside stakeholders are redacted in this report. The SSRS survey team designed the questionnaire in order to minimize potential bias from question ordering. For more information, please contact SSRS.

Respondents who completed on the web received a $5 electronic gift card incentive (some harder-to-reach groups received a $10 electronic gift card). Respondents who completed the survey on the phone received $10 via a physical check in the mail. In order to ensure data quality, cases were removed if they failed two or more quality checks: (1) attention check questions in the online version of the questionnaire, (2) had over 10% item non-response, or (3) had a length of less than 30% of the mean length by mode. Based on this criterion, 69 cases were removed.

Data were weighted to represent adults 18+ in the United States. The Panel-wide base weight adjusts for the SSRS Opinion Panel recruitment and retention process. Because all current panelists (except 2026 recruits) were invited to participate and no further sampling was performed, no further adjustments to the Panel-wide base weight were necessary before applying it to the survey data.

With the Panel-wide base weight applied, the survey-data were weighted to match the sample’s demographic profile to the same target population parameters used in the calibration of the entire SSRS Opinion Panel. The demographic variables included in weighting for the general population sample are gender, age, race/ethnicity, and education (including interactions between these categories), as well as region, civic engagement, density, frequency of internet use, voter registration, political party identification, religion, household makeup, and home ownership. Final calibrated weights are trimmed at the 2^nd and 98^th percentiles to prevent individual interviews from having too much influence.

The margin of sampling error including the design effect for the full sample is plus or minus 1 percentage points. Numbers of respondents and margins of sampling error for key subgroups are shown in the table below. For results based on other subgroups, the margin of sampling error may be higher. Sample sizes and margins of sampling error for other subgroups are available on request. Sampling error is only one of many potential sources of error and there may be other unmeasured error in this or any other public opinion poll. KFF public opinion and survey research is a charter member of the Transparency Initiative of the American Association for Public Opinion Research.

Medicaid, the nation’s health coverage program for people with low incomes, provides more than 39 million women across the nation with health and long-term care coverage. Women comprise the majority of the adult Medicaid population and the program offers coverage of a wide range of primary, preventive, specialty, and long-term care services that are important to women across their lifespans. Given the importance of the program for women and their families, changes to the program, such as the 2025 federal policy changes to Medicaid and the enactment of new work requirements for the Medicaid expansion population, will have significant implications for low-income women’s access to coverage and care. This data note presents key data points describing the current state of the Medicaid program as it affects women.  

In 2023 adult women comprised 37% of the overall Medicaid population and the majority of adults on the program (Figure 1).¹ Prior to the 2010 Affordable Care Act (ACA), women were more likely to qualify for Medicaid than men because of their lower incomes and because they were more likely to belong to one of Medicaid’s categories of eligibility for adults: pregnant, parent of a dependent child, senior, or person with a disability. The ACA added a new Medicaid eligibility category by extending Medicaid eligibility to nearly all adults under age 65 with incomes up to 138% of the federal poverty level (FPL), though women are still more likely than men to be covered by Medicaid.

• As of May 2026, 40 states and DC have opted to expand eligibility for Medicaid under the ACA, which allows women and men with low incomes below 138% FPL to qualify regardless of their pregnancy, parenting or disability status.  
• In the 10 states that have not expanded Medicaid under the ACA, adults only qualify if they meet income criteria AND belong to one of the previously mentioned categorical eligibility groups. While there are federal eligibility minimums, states have the option to expand eligibility levels for each group up to certain limits. As a result, income eligibility criteria vary for different groups of beneficiaries within as well as between states.
• In the states that have not adopted the ACA Medicaid expansion, approximately 576,000 women ages 19 to 64 with incomes below the federal poverty level and who are uninsured fall into a “coverage gap.” This is because they earn too much money to qualify for Medicaid in their state but not enough to qualify for assistance purchasing a private policy through their state’s ACA Marketplace, which is available for individuals with incomes between 100% FPL and 400% FPL.
• H.R. 1, the 2025 budget reconciliation law, has made significant changes to the Medicaid program. For the first time, eligibility for adults in the ACA Medicaid Expansion group will be conditioned on meeting work requirements, starting January 1, 2027. Prior KFF research has shown that most adult women covered by Medicaid meet work requirements or could qualify for one of the law’s exemptions (including being a parent of a child under age 14), but they are at risk of losing coverage because of the administrative burdens related to reporting requirements. In 2023, approximately 40% of adult women enrolled in Medicaid were enrolled via the ACA expansion pathway.² The Congressional Budget Office (CBO) estimates that these requirements will reduce federal Medicaid spending by $326 billion over the next 10 years but will also increase the number of uninsured by 5.3 million in 2034.

Medicaid covers a diverse population of women who face many social, economic, and health challenges that affect their ability to receive timely and high-quality health care.  

• In 2024, Medicaid covered 18% of adult women ages 19 to 64 in the United States, but coverage rates were higher among certain groups, such as women of color, single mothers, low-income women, and women who have not completed a high school education (Figure 2).  

• Differences in Medicaid eligibility levels and poverty rates across the states translate into vastly different Medicaid coverage rates for women across states, from a low of 9% in Utah and Texas to 32% in New Mexico (Figure 3).  

Adult women of reproductive age (19 to 49) comprise a quarter (24%) of the Medicaid population (Figure 1). Medicaid covers a wide range of reproductive health care services, including family planning, and pregnancy-related care including prenatal services, childbirth, and postpartum care—all without cost-sharing. Medicaid coverage of abortion services, however, is very limited under federal law and in most states.  

Family Planning 

Federal law requires state Medicaid programs to offer family planning benefits, but states determine the specific services and supplies for those who qualify through pre-ACA pathways. For the ACA expansion populations, the ACA requires states to cover all FDA approved, granted, and cleared  contraceptive methods, counseling on STIs and HIV, and screening for breast and cervical cancers. Research has found that most states have aligned their benefits and cover these services across all eligibility groups.  

• The federal government pays 90% of costs for family planning services, a higher federal matching rate than for other services (typically between 50% and 78%). Women covered by Medicaid cannot be charged any out-of-pocket costs for family planning services. 
• Federal law states that Medicaid beneficiaries have “free choice of provider,” which allows them to seek care from any qualified participating provider that offers the services. However, contrary to longstanding interpretation of the free choice of provider clause, a 2025 Supreme Court ruling, Medina v. Planned Parenthood South Atlantic, allows state Medicaid programs to disqualify clinics from participating in their networks if they offer abortion care in addition to other medical services. As of June 2026, at least seven states (AR, MO, MS, NE, OK, SC, and TX) have bans on Planned Parenthood’s participation in Medicaid, and several other states have proposed similar policies. Nationally, one in ten (10%) reproductive age women covered by Medicaid who received family planning services got their care at a Planned Parenthood clinic in 2023.
• In addition to the Medina ruling, H.R.1 established a one-year ban on federal Medicaid reimbursements to Planned Parenthood in all states and some other reproductive health providers that provide abortion services. The policy was in effect from July 2025 to July 2026. While this rule expired, future legislation could be enacted by Congress to reinstate this funding ban.
• Over half of states currently operate limited scope Medicaid family planning programs, which extend access to family planning services to uninsured women who do not qualify for full Medicaid coverage (often because their incomes exceed the Medicaid income thresholds).  

Maternity Care  

Medicaid is the largest single payer of pregnancy-related services, financing 40% of all U.S. births in 2024. In three states Medicaid covers more than 50% of all births. By federal law, all states provide Medicaid coverage without cost sharing for pregnancy-related services to pregnant people with incomes up to 138% of the federal poverty level (FPL), but many states extend eligibility to those at higher income levels. 

• Similar to family planning, there is no federal definition of what services states must cover under their traditional Medicaid programs for pregnant women beyond inpatient and outpatient hospital care, but states that have expanded Medicaid eligibility must cover all preventive services recommended by the United States Preventive Services Task Force (USPSTF) to individuals who qualify through this pathway, which includes a broad range of pregnancy-related preventive services. Overall, most states cover a broad range of maternity care services, including prenatal screenings, folic acid supplements, and breastfeeding supports. States may not charge cost-sharing for any pregnancy-related services.
• Historically, Medicaid coverage for pregnant people ended after 60 days. Due in part to the high rates of maternal mortality and morbidity in the United States and the disproportionately high rates of poor maternal outcomes experienced by Black and Native American pregnant people, there was a growing interest in expanding postpartum coverage beyond the 60 days. The federal American Rescue Act of 2021 gave states the option to extend postpartum coverage to pregnant people to a full year. To date, all states, with the exception of Arkansas, have extended postpartum coverage to 12 months.   
• In the 10 states that have not expanded Medicaid coverage under the ACA, many women lose Medicaid eligibly after the postpartum period. This is because the income eligibility for pregnancy-related care is typically considerably higher than that offered to parents of dependent children. Eligibility levels for parents in the states that have not expanded Medicaid range from 15% FPL in Texas to 105% FPL in Tennessee (Figure 4). In the states that have expanded Medicaid eligibility, most women with Medicaid financed births are able to remain enrolled in the program and have continuous coverage beyond the postpartum period. 

Abortion  

While the 2022 Dobbs decision overturning Roe v. Wade eliminated federal protections and allowed states to ban or severely restrict the provision of abortion, abortion remains legal and available in many states. However, the federal Hyde Amendment prohibits federal spending on abortions in all states, except when the pregnancy is a result of rape or incest, or when it jeopardizes the life of the pregnant person (Figure 5). States may use their own unmatched funds to cover abortions in other circumstances. As of July 2026, 29 states (including the 13 states where abortion provision is currently banned) and DC follow Hyde restrictions and 21 states cover abortions for Medicaid beneficiaries that are considered to be “medically necessary” and pay for these using only state funds. Nearly half of women of reproductive age with Medicaid coverage live in a state that follows Hyde amendment standards or currently bans the provision of abortion. In cases when Medicaid finances abortions for Medicaid enrollees, reimbursement rates tend to be low and often do not cover the full cost of the procedure.

As women age, their health needs generally shift from reproductive care to greater need for screening and management of chronic diseases, mental health care, and disability care (although many women in their reproductive years also have these health needs).  

Mental Health  

• In 2024, Medicaid covered over one in four (27%) adult women with any mental illness and 31% of adult women with a serious mental illness. 
• Medicaid’s behavioral health benefits include acute care services, long-term services and supports to enable people with chronic illness to receive community-based care. In addition, states with Medicaid expansion programs are required to cover 10 essential health benefits, which include mental health and substance use disorder services, including behavioral health treatment.  

Breast and Cervical Cancers 

• Under the Breast and Cervical Cancer Prevention and Treatment Act, states may extend Medicaid coverage for cancer treatment to uninsured women diagnosed with breast or cervical cancer through a federal screening program and receive a federal match for those services. In 2023, 44,000 women were enrolled in Medicaid through the Breast and Cervical Cancer Program.  
• Preventive services for breast and cervical cancers are required benefits in ACA Medicaid Expansion programs. States are required to cover mammograms and pap tests, genetic (BRCA) screening for high-risk women, and breast cancer preventive medication for high-risk women. Most states cover the screening tests for all beneficiaries. However, coverage for other services such as such as colposcopy following an abnormal pap result (which will be a required as a covered services under the HRSA Women’s Preventive Services  Guidelines effective January 2027) and genetic screening for women at higher risk of breast cancer is more uneven across state eligibility pathways.  

Women with Disabilities  

• Medicaid covers four in ten (41%) nonelderly women who have a broad range of physical and mental disabilities, including physical impairments, severe mental illnesses, and specific conditions such as muscular dystrophy, cystic fibrosis, and HIV/AIDS (Figure 6).³ In addition, Medicaid also covers some nonelderly women who separately also qualify for Medicare coverage due to long-term disabilities (discussed below). 
• Benefits that Medicaid covers include: assistance with medical and supportive services including rehabilitation, transportation, and therapeutic services, which help people with disabilities live independently and are not typically covered by private health insurance plans. Long-term services, including home health care, are another critical health benefit for women with disabilities that has very limited coverage through commercial plans but is covered by Medicaid.  

Medicare-Medicaid Enrollees and Long-Term Care 

Medicare provides health coverage to people 65 and older and younger people with long-term disabilities. Medicaid provides coverage to approximately 12 million Medicare beneficiaries (20% of all Medicare beneficiaries) with low incomes and modest assets. These individuals are often referred to as “dually eligible beneficiaries,” and in 2023, women of all ages accounted for 60% of this group (Figure 7). Many of these beneficiaries have extensive and costly health needs.  

• The majority of dually eligible beneficiaries qualify for full Medicaid benefits and may receive coverage for services that Medicare does not currently cover, such as dental and vision care, and long-term services and supports. Other dually eligible beneficiaries may only receive assistance with their Medicare premiums and/or cost sharing through the Medicare Savings Programs, but not full Medicaid benefits, if they meet an income and asset test. 

• Medicaid covers a continuum of long-term services and supports ranging from home care (HCBS) that allow persons to live independently in their own homes or in other community settings to institutional care provided in nursing facilities and intermediate care facilities for individuals with intellectual disabilities. In 2023, HCBS represented 64% of total Medicaid expenditures on long-term care (LTC).  
• Since women are more likely to live longer and experience higher rates of chronic illness and disability than men, they are more likely to require long-term services in their lifetime. Approximately two-thirds of nursing home residents (61%) and people receiving home health care (60%) are women. Medicaid coverage provides access to these long-term services, which would otherwise be unaffordable for women with fixed incomes (in 2025, nursing home care averaged more than $114,975 annually for a semi-private room).  

Compared to their uninsured counterparts, women with Medicaid experience fewer barriers to care and on several measures have utilization rates comparable to low-income women with private insurance.  

• Women covered by Medicaid use primary and preventive health services, such as pap smears and mammograms, at rates comparable to women with private insurance and at higher rates than uninsured women (Figure 8).  

• Women with Medicaid coverage are less likely than uninsured women to experience cost barriers. Compared to low-income women with private insurance, women on Medicaid were less likely to report that they delayed or went without care due to cost, likely attributable to the fact that Medicaid does not charge deductibles, rarely charges premiums and has only nominal cost-sharing. Affordability, however, is still a problem for some women in the program because they are typically low-income and have to pay out of pocket costs in states that impose caps on the number of covered visits or prescriptions or charge copayments for prescription drugs (for non-pregnant adults). Three in 10 low-income women on Medicaid report that they had not filled a prescription (31%) in the past year because of the cost (Figure 9).  

1. KFF analysis of the T-MSIS Research Identifiable Files, 2023 (Preliminary) ↩︎
2. KFF analysis of the T-MSIS Research Identifiable Files, 2023 (Preliminary) ↩︎
3. KFF estimate based on the 2024 American Community Survey, 1-year estimates ↩︎