In 2023, some 47.6 percent of Medicaid and CHIP enrollees were aged between 18 and 64 years, while adults aged 65 years accounted for only eight percent of enrollees. Medicaid program is funded jointly by the federal and the state governments, it provided coverage to nearly 19.5 percent of the U.S. population in 2022. Medicaid vs CHIPMedicaid and the Children’s Health Insurance Program (CHIP) both provide health insurance coverage for children from low-income families. Children who are not eligible for Medicaid but who would otherwise be unable to obtain insurance through a family plan are covered by CHIP. More than five million children were enrolled in CHIP in the U.S. in 2023. Medicaid and CHIP funding rateThe Federal Medical Assistance Percentages (FMAPs) are used to calculate the amount of federal matching funds for State Medicare and CHIP programs. To encourage states to expand coverage for uninsured children the federal matching rates for CHIP are generally 15 points higher than the Medicaid rate. However, unlike permanent federal funding for Medicaid, CHIP federal funding is capped and due to expire in FY 2027.

The Medicaid Managed Care Enrollment Report profiles enrollment statistics on Medicaid managed care programs on a plan-specific level. The managed care enrollment statistics include enrollees receiving comprehensive benefits and limited benefits and are point-in-time counts. Because Medicaid beneficiaries may be enrolled concurrently in more than one type of managed care program (e.g., a Comprehensive MCO and a BHO), users should not sum enrollment across all program types, since the total would count individuals more than once and, in some states, exceed the actual number of Medicaid enrollees. Comprehensive MCOs cover acute, primary, and specialty medical care services; they may also cover behavioral health, long-term services and supports, and other benefits in some states. Limited benefit managed care programs, including PCCM, MLTSS only, BHO, Dental, Transportation, and Other cover a narrower set of services. The “Total Medicaid Enrollees” column represents an unduplicated count of all beneficiaries in FFS and any type of managed care, including Medicaid-only and dually eligible individuals receiving full Medicaid benefits or Medicaid cost sharing. "--" indicates states that do not operate programs of a given type. 0 signifies that a state operated a program of this type in 2014, but it ended before July 1, 2014, or began after that date.

California has more Medicaid and CHIP enrollees than any other state in the United States. As of April 2023, approximately ** million Americans were enrolled in the Medicaid health insurance programs in California, which accounted for approximately ** percent of the total number of Medicaid enrollees nationwide (**** million). Blow to Medicaid expansion plans California is one of many states that has expanded its Medicaid program under the Affordable Care Act (ACA) to encourage more low-income adults to sign up for health coverage. One of the original aims of the ACA was to limit some of the variations in state Medicaid programs, but the Supreme Court ruled that the expansion should be optional. Governors of the states that did not expand said they were concerned about long-term costs. California is the leading state for Medicaid expenditure, spending approximately **** billion U.S. dollars in FY2020. Health coverage for children The Children’s Health Insurance Program (CHIP) was created as a complement to Medicaid, expanding the reach of government-funded health coverage to more children in low-income families. As of May 2021, over **** million children were enrolled in Medicaid/CHIP programs in California, more than any other state. As of January 2021, the median Medicaid/CHIP eligibility level for children was *** percent of the federal poverty level.

This data set includes monthly counts and rates (per 1,000 beneficiaries) of behavioral health services, including emergency department services, inpatient services, intensive outpatient/partial hospitalizations, outpatient services, or services delivered through telehealth, provided to Medicaid and CHIP beneficiaries, by state. Users can filter by either mental health disorder or substance use disorder. These metrics are based on data in the T-MSIS Analytic Files (TAF). Some states have serious data quality issues for one or more months, making the data unusable for calculating behavioral health services measures. To assess data quality, analysts adapted measures featured in the DQ Atlas. Data for a state and month are considered unusable if at least one of the following topics meets the DQ Atlas threshold for unusable: Total Medicaid and CHIP Enrollment, Claims Volume - IP, Claims Volume - OT, Diagnosis Code - IP, Diagnosis Code - OT. Please refer to the DQ Atlas at http://medicaid.gov/dq-atlas for more information about data quality assessment methods. Cells with a value of “DQ” indicate that data were suppressed due to unusable data. Some cells have a value of “DS”. This indicates that data were suppressed for confidentiality reasons because the group included fewer than 11 beneficiaries.

This map shows where people have Medicaid or means-tested healthcare coverage in the US (ages under 65). This is shown by State, County, and Census Tract, and uses the most current ACS 5-year estimates.The map shows the percentage of the population with Medicaid or means-tested coverage, and also shows the total count of population with Medicaid or means-tested coverage. Because of Medicare starting at age 65, this map represents the population under 65. This map shows a pattern using both centroids and boundaries. This helps clarify where specific areas reach. The data shown is current-year American Community Survey (ACS) data from the US Census. The data is updated each year when the ACS releases its new 5-year estimates. To see the original layers used in this map, visit this group. To learn more about the vintage and data source, click here to visit the Living Atlas layer used in the map.To learn more about when the ACS releases data updates, click here.

Over ** million Americans were estimated to be enrolled in the Medicaid program as of 2023. That is a significant increase from around ** million ten years earlier. Medicaid is basically a joint federal and state health program that provides medical coverage to low-income individuals and families. Currently, Medicaid is responsible for ** percent of the nation’s health care bill, making it the third-largest payer behind private insurances and Medicare. From the beginning to ObamacareMedicaid was implemented in 1965 and since then has become the largest source of medical services for Americans with low income and limited resources. The program has become particularly prominent since the introduction of President Obama’s health reform – the Patient Protection and Affordable Care Act - in 2010. Medicaid was largely impacted by this reform, for states now had the opportunity to expand Medicaid eligibility to larger parts of the uninsured population. Thus, the percentage of uninsured in the United States decreased from over ** percent in 2010 to *** percent in 2022. Who is enrolled in Medicaid?Medicaid enrollment is divided mainly into four groups of beneficiaries: children, adults under 65 years of age, seniors aged 65 years or older, and disabled people. Children are the largest group, with a share of approximately ** percent of enrollees. However, their share of Medicaid expenditures is relatively small, with around ** percent. Compared to that, disabled people, accounting for **** percent of total enrollment, were responsible for **** percent of total expenditures. Around half of total Medicaid spending goes to managed care and health plans.

This data set includes monthly counts and rates (per 1,000 beneficiaries) of acute care services, including emergency department (ED) visits, inpatient stays, intensive care unit (ICU) stays, and ICU stays that include ventilator use, provided to Medicaid and CHIP beneficiaries, by state. Users can filter to acute care services for any reason, or acute care services for COVID-19.

These metrics are based on data in the T-MSIS Analytic Files (TAF). Some states have serious data quality issues for one or more months, making the data unusable for calculating acute care services measures. To assess data quality, analysts adapted measures featured in the DQ Atlas. Data for a state and month are considered unusable if at least one of the following topics meets the DQ Atlas threshold for unusable: Total Medicaid and CHIP Enrollment, Claims Volume - IP, Claims Volume - OT, Diagnosis Code - IP, Diagnosis Code - OT, Procedure Codes - OT Professional. Please refer to the DQ Atlas at http://medicaid.gov/dq-atlas for more information about data quality assessment methods. Cells with a value of “DQ” indicate that data were suppressed due to unusable data.

Some cells have a value of “DS”. This indicates that data were suppressed for confidentiality reasons because the group included fewer than 11 beneficiaries.

In 2022, just under four in ten Medicaid/CHIP enrollees were White, non-Hispanic. In comparison, roughly three-quarters of Medicare beneficiaries were White. The Affordable Care Act (ACA) Medicaid expansion in 2014, has helped reduce racial disparities in access to healthcare in the United States.

Medicaid eligibility

Medicaid provides health coverage to certain low-income individuals, families, children, pregnant women, the elderly, and persons with disabilities. Each state has its own Medicaid eligibility criteria in accordance with federal guidelines. As a result, Medicaid eligibility and benefits differ widely from state to state. Medicaid expansion provision under the Affordable Care Act (ACA) allows states to provide coverage for low-income adults by expanding eligibility for Medicaid to 138 percent of the federal poverty line (FPL).

Medicaid coverage gap

Uninsured individuals who live in states that have chosen not to expand Medicaid under the Affordable Care Act (ACA) are referred to as being in the Medicaid coverage gap. As of January 2021, 12 states have not adopted the Medicaid expansion provision under the Affordable Care Act (ACA). More than two million uninsured adults fall into this coverage gap, and among them, more than 60 percent are people of color.

This dataset tracks the updates made on the dataset "Behavioral Health Services Provided to the Medicaid and CHIP Population" as a repository for previous versions of the data and metadata.

This map shows where people have Medicaid or means-tested healthcare coverage in the US (ages under 65). This is shown by State, County, and Census Tract, and uses the most current ACS 5-year estimates.

This data set includes monthly counts and rates (per 1,000 beneficiaries) of services provided via telehealth, including live audio video, remote patient monitoring, store and forward, and other telehealth, to Medicaid and CHIP beneficiaries, by state. These metrics are based on data in the T-MSIS Analytic Files (TAF). Some states have serious data quality issues for one or more months, making the data unusable for calculating telehealth services measures. To assess data quality, analysts adapted measures featured in the DQ Atlas. Data for a state and month are considered unusable if at least one of the following topics meets the DQ Atlas threshold for unusable: Total Medicaid and CHIP Enrollment, Claims Volume - OT, Procedure Codes - OT Professional. Please refer to the DQ Atlas at http://medicaid.gov/dq-atlas for more information about data quality assessment methods. Cells with a value of “DQ” indicate that data were suppressed due to unusable data. Some cells have a value of “DS”. This indicates that data were suppressed for confidentiality reasons because the group included fewer than 11 beneficiaries.

This data set includes annual counts and percentages of Medicaid and Children’s Health Insurance Program (CHIP) enrollees by primary language spoken (English, Spanish, and all other languages). Results are shown overall; by state; and by five subpopulation topics: race and ethnicity, age group, scope of Medicaid and CHIP benefits, urban or rural residence, and eligibility category. These results were generated using Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF) Release 1 data and the Race/Ethnicity Imputation Companion File. This data set includes Medicaid and CHIP enrollees in all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands who were enrolled for at least one day in the calendar year, except where otherwise noted. Enrollees in Guam, American Samoa, the Northern Mariana Islands, and select states with data quality issues with the primary language variable in TAF are not included. Results shown for the race and ethnicity subpopulation topic exclude enrollees in the U.S. Virgin Islands. Results shown overall (where subpopulation topic is "Total enrollees") exclude enrollees younger than age 5 and enrollees in the U.S. Virgin Islands. Results for states with TAF data quality issues in the year have a value of "Unusable data." Some rows in the data set have a value of "DS," which indicates that data were suppressed according to the Centers for Medicare & Medicaid Services’ Cell Suppression Policy for values between 1 and 10. This data set is based on the brief: "Primary language spoken by the Medicaid and CHIP population in 2020." Enrollees are assigned to a primary language category based on their reported ISO language code in TAF (English/missing, Spanish, and all other language codes) (Primary Language). Enrollees are assigned to a race and ethnicity subpopulation using the state-reported race and ethnicity information in TAF when it is available and of good quality; if it is missing or unreliable, race and ethnicity is indirectly estimated using an enhanced version of Bayesian Improved Surname Geocoding (BISG) (Race and ethnicity of the national Medicaid and CHIP population in 2020). Enrollees are assigned to an age group subpopulation using age as of December 31st of the calendar year. Enrollees are assigned to the comprehensive benefits or limited benefits subpopulation according to the criteria in the "Identifying Beneficiaries with Full-Scope, Comprehensive, and Limited Benefits in the TAF" DQ Atlas brief. Enrollees are assigned to an urban or rural subpopulation based on the 2010 Rural-Urban Commuting Area (RUCA) code associated with their home or mailing address ZIP code in TAF (Rural Medicaid and CHIP enrollees in 2020). Enrollees are assigned to an eligibility category subpopulation using their latest reported eligibility group code, CHIP code, and age in the calendar year. Please refer to the full brief for additional context about the methodology and detailed findings. Future updates to this data set will include more recent data years as the TAF data become available.

Number of Managed Care Programs Enrolling Certain Populations on a Mandatory or Voluntary Basis at any point in 2022

Additional file 1: Appendix 1. Detailed Methods. Appendix 2. Pre-Interview Survey. Appendix 3. Semi-Structured Interview Guide.

As of August 1, 2024, approximately 2.5 million Medicaid enrollees have been disenrolled in Texas, the highest number of people disenrolled across all states in the United States. Overall, more than 24.5 million people in the United States have lost their Medicaid coverage, the majority of those terminations were for so-called procedural reasons, which means that the enrollees did not finish the renewal process for various reasons.

This table presents three populations of beneficiaries who could benefit from different levels of integrated care, 2017-2021: (1) beneficiaries who received services for a behavioral health (BH) condition; (2) beneficiaries who received services for a behavioral health condition who also received services for at least one of a number of select physical health (PH) conditions (a subset of population 1); and (3) beneficiaries prescribed medications for substance use disorders who do not have a medical claim for a behavioral health condition (a subset of population 1). Some states have serious data quality issues, making the data unusable for identifying this population. To assess data quality, analysts used measures featured in the DQ Atlas. Data for a state are considered unusable based on DQ Atlas thresholds for the following topics: Total Medicaid and CHIP Enrollment, Claims Volume - IP, Claims Volume - OT, Claims Volume - IP, Diagnosis Code - IP, Diagnosis Code - OT, Procedure Codes - OT Professional, Gender, Age, Zip code, Race and ethnicity, Eligibility group code, Enrollment in CMC Plans. Data from Maryland, Tennessee, and Utah are omitted for the tables due to data quality concerns. Maryland was excluded in 2017 due to unusable diagnosis codes in the IP file and the OT file. Tennessee was excluded due to unusable diagnosis codes in the IP file in 2017 - 2019. Utah was excluded due to unusable procedure codes on OT professional claims in 2017 - 2020. In addition, states with a high data quality concern on one or more measures are noted in the table in the "Data Quality" column. Please refer to the DQ Atlas at http://medicaid.gov/dq-atlas for more information about data quality assessment methods.

This data set includes monthly counts and percentages of Medicaid and CHIP beneficiaries, by state, who received at least one service for each of the following conditions: acute bronchitis, acute respiratory distress, bronchitis not other specified (NOS), COVID-19 (based on the presence of diagnosis code U07.1), influenza, lower or acute respiratory infection, pneumonia, respiratory infection NOS, and suspected COVID-19 (based on the presence of diagnosis code B97.29). These metrics are based on data in the T-MSIS Analytic Files (TAF). Some states have serious data quality issues for one or more months, making the data unusable for calculating COVID-related conditions measures. To assess data quality, analysts adapted measures featured in the DQ Atlas. Data for a state and month are considered unusable if at least one of the following topics meets the DQ Atlas threshold for unusable: Total Medicaid and CHIP Enrollment, Claims Volume - IP, Claims Volume - OT, Claims Volume - IP, Diagnosis Code - IP, Diagnosis Code - OT, Procedure Codes - OT Professional. Please refer to the DQ Atlas at http://medicaid.gov/dq-atlas for more information about data quality assessment methods. Cells with a value of “DQ” indicate that data were suppressed due to unusable data. Some cells have a value of “DS”. This indicates that data were suppressed for confidentiality reasons because the group included fewer than 11 beneficiaries.

All states (including the District of Columbia) are required to provide data to The Centers for Medicare & Medicaid Services (CMS) on a range of Medicaid and Children’s Health Insurance Program (CHIP) indicators related to key application, eligibility, enrollment and call center processes. These data reflect enrollment activity for all populations receiving comprehensive Medicaid and CHIP benefits in all states, as well as state program performance. States submit this data via the Performance Indicator dataset. Further information about this dataset is available at: https://www.medicaid.gov/medicaid/national-medicaid-chip-program-information/medicaid-chip-enrollment-data/performance-indicator-technical-assistance/index.html.

Children accounted for 36.5 percent of Medicaid enrollees in 2021, which was the largest share of all enrollment groups. The elderly and persons with disabilities had the smallest shares, but together they accounted for more than half of all Medicaid expenditure.

Medicaid expenditures per enrollee Medicaid is a joint federal and state health care program in the United States. The program provides medical coverage to millions of Americans and supports a variety of enrollment groups, particularly senior citizens and individuals with disabilities. Medicaid per enrollee spending is significantly higher for these two groups because they require more frequent and costly long-term care in the community and nursing homes. In 2022 of the total U.S. health expenditure on home health care, Medicaid paid one-third.

Millions of Americans are uninsured The United States has a multi-payer health care system, meaning that some Americans will be covered by private health insurance, and others will be covered by a government program such as Medicaid. However, approximately 27.6 million people in the U.S. had no health insurance in 2021, and should they require health care, they would have to pay the full price out of their own pocket. This becomes a real problem for many because the United States has the most expensive health care system in the world.

This data set includes annual counts and percentages of Medicaid and Children’s Health Insurance Program (CHIP) enrollees by race and ethnicity overall and by three subpopulation topics: scope of Medicaid and CHIP benefits, age group, and eligibility category. These results were generated using Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF) Release 1 data and the Race/Ethnicity Imputation Companion File. This data set includes Medicaid and CHIP enrollees in all 50 states, the District of Columbia, and Puerto Rico who were enrolled for at least one day in the calendar year. Enrollees in Guam, American Samoa, the Northern Mariana Islands, and the U.S. Virgin Islands are not included. Results shown for the age group and eligibility category subpopulation topics only include enrollees with comprehensive Medicaid and CHIP benefits in the year. Some rows in the data set have a value of "DS," which indicates that data were suppressed according to the Centers for Medicare & Medicaid Services’ Cell Suppression Policy for values between 1 and 10. This data set is based on information shown in the brief: "Race and ethnicity of the national Medicaid and CHIP population in 2020." Enrollees are assigned to six race and ethnicity categories using the state-reported race and ethnicity information in TAF when it is available and of good quality; if it is missing or unreliable, race and ethnicity is indirectly estimated using an enhanced version of Bayesian Improved Surname Geocoding (BISG). Enrollees are assigned to a child (ages 0-18) or adult (ages 19 and older) subpopulation using age as of December 31st of the calendar year. Enrollees are assigned to the comprehensive benefits or limited benefits subpopulation according to the criteria in the "Identifying Beneficiaries with Full-Scope, Comprehensive, and Limited Benefits in the TAF" DQ Atlas brief. Enrollees are assigned to an eligibility category subpopulation using their latest reported eligibility group code, CHIP code, and age in the calendar year. Please refer to the full brief for additional context about the methodology and detailed findings. Future updates to this data set will include more recent data years as the TAF data become available.