5 Insights on Medicaid Enrollment

November 18, 2025

Medicaid enrollment declined by 7.6 percent in Fiscal Year (FY) 2025, and considerable challenges are on the horizon for the program.

Kaiser Family Foundation’s (KFF) annual Medicaid Budget Survey outlines how Medicaid—which provides health coverage and long-term care for one in five Americans—is changing in response to new federal policies and legislation.

“For Medicaid, states are navigating the new ‘normal’ for their programs following the expiration of pandemic-era policies while contending with shifts in state fiscal conditions and longer-term fiscal uncertainty,” the issue brief notes.

Here’s what you need to know:

• Driving the trend:  Most states had completed the unwinding of the pandemic-era continuous enrollment through the middle of FY 2025.
  • “Competing upward and downward enrollment pressures are expected to result in flat Medicaid enrollment growth (0.2%) in FY 2026,” the issue brief notes.
• Impact of unwinding:  With the full unwinding of pandemic-era provisions, enrollment in Medicaid and CHIP was down 18 percent in June 2025 compared to March 2023, but was still 9 percent above February 2020 levels.
• What to watch:  Medicaid coverage for GLP-1 medications for obesity is declining due to additional restrictions in coverage. There are 16 states that cover GLP-1 medications for obesity; coverage for diabetes and cardiovascular disease is required.
• Challenges:  Changes stemming from H.R.1. will lead to over $900 billion in federal Medicaid cuts. Work requirements and other restrictions will add to these challenges.
• Why it matters:  HAP continues to highlight the ways Medicaid supports hospitals and the communities they serve.
  • Following the passage of the federal reconciliation bill, Pennsylvania hospitals will absorb a direct payment cut of about $4.5 billion over the next decade—with average Medicaid reimbursement dropping from 71 cents per dollar it costs to deliver care to 64 cents.

The KFF issue brief and a news release are available online.