The number of children enrolled in Medicaid was projected to reach 31 million by 2027, which would account for nearly 40 percent of total enrollment. Historically, children have been the largest group of Medicaid enrollees.

CHIP builds on Medicaid’s coverage The Children’s Health Insurance Program (CHIP) provides insurance coverage to children in families with incomes too high to qualify for Medicaid but too low to pay for private health insurance – there were approximately 9.6 million CHIP enrollees in 2018. CHIP is jointly financed by states and the federal government, but each state can decide how to design its program: they can implement it by expanding Medicaid, creating a separate plan, or a combination of both approaches.

Income eligibility levels for children The introduction of the Affordable Care Act (ACA) strengthened children’s health coverage by expanding eligibility levels in all states. For children of all ages, the ACA established a minimum Medicaid eligibility level of 138 percent of the federal poverty level (FPL), but many states have set higher income limits. In 2020, the median upper income eligibility level for children for Medicaid/CHIP was 255 percent of the FPL.

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.

This data set includes annual counts and percentages of Medicaid and Children’s Health Insurance Program (CHIP) enrollees who received a well-child visit paid for by Medicaid or CHIP, overall and by five subpopulation topics: age group, race and ethnicity, urban or rural residence, program type, and primary language. 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, except where otherwise noted. Enrollees in Guam, American Samoa, and the Northern Mariana Islands are not included. Results include enrollees with comprehensive Medicaid or CHIP benefits for all 12 months of the year and who were younger than age 19 at the end of the calendar year. Results shown for the race and ethnicity subpopulation topic exclude enrollees in the U.S. Virgin Islands. Results shown for the primary language subpopulation topic exclude select states with data quality issues with the primary language variable in TAF. 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: "Medicaid and CHIP enrollees who received a well-child visit in 2020." Enrollees are identified as receiving a well-child visit in the year according to the Line 6 criteria in the Form CMS-416 reporting instructions. Enrollees are assigned to an age group subpopulation using age as of December 31st of the calendar year. 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 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 a program type subpopulation based on the CHIP code and eligibility group code that applies to the majority of their enrolled-months during the year (Medicaid-Only Enrollment; M-CHIP and S-CHIP Enrollment). Enrollees are assigned to a primary language subpopulation based on their reported ISO language code in TAF (English/missing, Spanish, and all other language codes) (Primary Language). 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.

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.

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 who received a well-child visit paid for by Medicaid or CHIP, overall and by five subpopulation topics: age group, race and ethnicity, urban or rural residence, program type, and primary language. 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, except where otherwise noted. Enrollees in Guam, American Samoa, and the Northern Mariana Islands are not included. Results include enrollees with comprehensive Medicaid or CHIP benefits for all 12 months of the year and who were younger than age 19 at the end of the calendar year. Results shown for the race and ethnicity subpopulation topic exclude enrollees in the U.S. Virgin Islands. Results shown for the primary language subpopulation topic exclude select states with data quality issues with the primary language variable in TAF. 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: "Medicaid and CHIP enrollees who received a well-child visit in 2020." Enrollees are identified as receiving a well-child visit in the year according to the Line 6 criteria in the Form CMS-416 reporting instructions. Enrollees are assigned to an age group subpopulation using age as of December 31st of the calendar year. 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 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 a program type subpopulation based on the CHIP code and eligibility group code that applies to the majority of their enrolled-months during the year (Medicaid-Only Enrollment; M-CHIP and S-CHIP Enrollment). Enrollees are assigned to a primary language subpopulation based on their reported ISO language code in TAF (English/missing, Spanish, and all other language codes) (Primary Language). 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.

Medicaid is an important public health insurance for individuals with a low income, those that are pregnant, disabled or are children. It was projected that by 2020 there would be approximately 76.7 million Medicaid enrollees. By 2027 that number is expected to increase to 82 million individuals covered.

Medicaid in the focus

Medicaid has recently been in the news for several reasons. A proposed Medicaid expansion was announced with the implementation of the Affordable Care Act in 2010. According to the expansion, all states were given the option to expand Medicaid programs to help provide insurance coverage to millions of U.S. Americans. As of 2019, 32 states have accepted federal funding to expand their Medicaid programs. Medicaid, after Medicare and private insurance, provides a significant proportion of the total health expenditures in the United States. In general, Medicaid expenditure, like the number of enrollees, has been growing over time.

Medicaid demographics

A significant proportion of Medicaid enrollees in the U.S. are children and low-income adults. Despite children accounting for most of the enrollees in the Medicaid program, the largest percentage of expenditures for Medicaid is dedicated to those enrolled as a disabled individual. Expenditures for the program also vary regionally. The states with the highest Medicaid expenditures include California, New York and Texas, to name a few.

There were approximately 28.1 million children enrolled in the Medicaid health care program in 2018, which accounted for nearly 40 percent of the total number of 74 million Medicaid enrollees. Enrollment numbers in each of the four groups have been consistent for several years.

Medicaid expenditure by eligibility group Medicaid is a joint federal and state health care program in the United States. States administer the program, but they must meet some core federal requirements, one of which includes providing health coverage to children in some low-income families. Medicaid expenditure on children was estimated to have totaled 107.2 billion U.S. dollars in 2017, which accounted for nearly 20 percent of the total expenditure during the year – the only enrollment group with a larger share of expenditures was persons with disabilities.

Health insurance options for children The Children’s Health Insurance Program (CHIP) was signed into U.S. law in 1997 and increased health coverage to uninsured children under the age of 19 who were not eligible for Medicaid. States can implement CHIP by expanding Medicaid or operating it as a separate program. More than 9.6 million children were enrolled in the program during 2018, around two million of whom were in the state of California.

This data set includes annual counts and percentages of Medicaid and Children’s Health Insurance Program (CHIP) enrollees who received mental health (MH) or substance use disorder (SUD) services, overall and by six subpopulation topics: age group, sex or gender identity, race and ethnicity, urban or rural residence, eligibility category, and primary language. 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, ages 12 to 64 at the end of the calendar year, who were not dually eligible for Medicare and were continuously enrolled with comprehensive benefits for 12 months, with no more than one gap in enrollment exceeding 45 days. Enrollees who received services for both an MH condition and SUD in the year are counted toward both condition categories. Enrollees in Guam, American Samoa, the Northern Mariana Islands, and select states with TAF data quality issues are not included. Results shown for the race and ethnicity subpopulation topic exclude enrollees in the U.S. Virgin Islands. Results shown for the primary language subpopulation topic exclude select states with data quality issues with the primary language variable in TAF. 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: "Medicaid and CHIP enrollees who received mental health or SUD services in 2020." Enrollees are assigned to an age group subpopulation using age as of December 31st of the calendar year. Enrollees are assigned to a sex or gender identity subpopulation using their latest reported sex in the calendar year. 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 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. Enrollees are assigned to a primary language subpopulation based on their reported ISO language code in TAF (English/missing, Spanish, and all other language codes) (Primary Language). 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.

This data set includes annual counts and percentages of Medicaid and Children’s Health Insurance Program (CHIP) enrollees by urban or rural residence. Results are shown overall; by state; and by four subpopulation topics: scope of Medicaid and CHIP benefits, race and ethnicity, disability-related eligibility category, and managed care participation. 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, and the Northern Mariana Islands are not included. Results shown overall (where subpopulation topic is "Total enrollees") and for the race and ethnicity subpopulation topic exclude enrollees in the U.S. Virgin Islands. Results shown for the race and ethnicity, disability category, and managed care participation subpopulation topics only include Medicaid and CHIP enrollees with comprehensive benefits. Results shown for the disability category subpopulation topic only include working-age adults (ages 19 to 64). 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: "Rural Medicaid and CHIP enrollees in 2020." Enrollees are assigned to an urban or rural category based on the 2010 Rural-Urban Commuting Area (RUCA) code associated with their home or mailing address ZIP code in TAF. 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 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 a disability category subpopulation using their latest reported eligibility group code and age in the year (Medicaid enrollees who qualify for benefits based on disability in 2020). Enrollees are assigned to a managed care participation subpopulation based on the managed care plan type code that applies to the majority of their enrolled-months during the year (Enrollment in CMC Plans). 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.

2023 saw the largest expenditures on Medicaid in U.S. history. At that time about 894 billion U.S. dollars were expended on the Medicaid public health insurance program that aims to provide affordable health care options to low income residents and people with disabilities. Medicaid was signed into law in 1965. By 1975 around 13 billion U.S. dollars were spent on the program. Groups covered by Medicaid There are several components of the Medicaid health insurance program. The Children’s Health Insurance Program (CHIP) was started in 1997 to provide health coverage to families and children that could not afford care. As of 2021, children represented the largest distribution of Medicaid enrollees. Despite having the largest proportion of enrollees, those that were enrolled in Medicaid as children had the lowest spending per enrollee. As of 2021, disabled Medicaid enrollees had the highest spending per enrollee. Medicaid expenditures Currently, Medicaid accounts for 19 percent of all health care expenditure in the United States. Expenditures on Medicaid programs vary among the U.S. states and depend heavily on whether Medicaid expansion was accepted after the Affordable Care Act was enacted. California and New York are the top states with the highest Medicaid expenditures. It is projected that Medicaid expenditure will continue to increase at both the state and federal levels.

This data set includes annual counts and percentages of Medicaid enrollees who are eligible for benefits based on disability, overall; by reason for qualification of disability benefits; and by four subpopulation topics: age group, dual eligibility status, race and ethnicity, and managed care participation. 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 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, and the Northern Mariana Islands are not included. The Children’s Health Insurance Program (CHIP) does not confer eligibility based on disability, so Medicaid expansion CHIP (M-CHIP) and separate CHIP (S-CHIP) enrollees are not included. Results shown for the race and ethnicity subpopulation topic exclude enrollees in the U.S. Virgin Islands. Results shown for the dual eligibility, race and ethnicity, and managed care participation subpopulation topics are restricted to working-age adults (ages 19 to 64) with comprehensive Medicaid benefits. 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: "Medicaid enrollees who qualify for benefits based on disability in 2020." Enrollees are assigned to a disability category based on their latest reported eligibility group code and age in the calendar year. Enrollees are assigned to an age group subpopulation using age as of December 31st of the calendar year. Enrollees are assigned to a dual eligibility status subpopulation based on the dual eligibility code that applies to the majority of their enrolled-months during the year (Dual Eligibility Code). 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 a managed care participation subpopulation based on the managed care plan type code that applies to the majority of their enrolled-months during the year (Enrollment in CMC Plans). 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.

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.

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.

This data set includes annual counts and percentages of Medicaid and Children’s Health Insurance Program (CHIP) enrollees who received a well-child visit paid for by Medicaid or CHIP, overall and by five subpopulation topics: age group, race and ethnicity, urban or rural residence, program type, and primary language. 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, except where otherwise noted. Enrollees in Guam, American Samoa, and the Northern Mariana Islands are not included. Results include enrollees with comprehensive Medicaid or CHIP benefits for all 12 months of the year and who were younger than age 19 at the end of the calendar year. Results shown for the race and ethnicity subpopulation topic exclude enrollees in the U.S. Virgin Islands. Results shown for the primary language subpopulation topic exclude select states with data quality issues with the primary language variable in TAF. 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: "Medicaid and CHIP enrollees who received a well-child visit in 2020." Enrollees are identified as receiving a well-child visit in the year according to the Line 6 criteria in the Form CMS-416 reporting instructions. Enrollees are assigned to an age group subpopulation using age as of December 31st of the calendar year. 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 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 a program type subpopulation based on the CHIP code and eligibility group code that applies to the majority of their enrolled-months during the year (Medicaid-Only Enrollment; M-CHIP and S-CHIP Enrollment). Enrollees are assigned to a primary language subpopulation based on their reported ISO language code in TAF (English/missing, Spanish, and all other language codes) (Primary Language). 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.

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.

In FY 2022, Medicaid expenditure on disabled persons was estimated to have totaled 234 billion U.S. dollars, which was more than any other enrollment group. Disabled individuals also had the highest per enrollee Medicaid costs during the year. The high costs of health care Federal and state governments together spent an estimated 640 billion U.S. dollars on the Medicaid health insurance program in 2019. Despite having the smallest shares of Medicaid enrollees, the elderly and disabled groups combined to account for more than half of all Medicaid expenditure in 2019. These two groups have a significantly higher per enrollee expenditure because they have greater long-term needs – Medicaid expenditure on acute care and long-term care benefits combined for approximately 260 billion U.S. dollars in 2017. Which eligibility group has the most enrollees? Elderly individuals can qualify for Medicaid through several pathways, but an income-based methodology is primarily used to determine eligibility for most adults, pregnant women, and children. Children accounted for 37.5 percent of Medicaid enrollees in 2019, which was the largest share of all enrollment groups. Around 28 million children are enrolled in Medicaid programs across the United States, and the number of enrollees is projected to top 30 million in the coming years.

This data set includes annual counts and rates of Medicaid- and Children’s Health Insurance Program (CHIP)-covered live-birth deliveries that were preterm or with a severe maternal morbidity (SMM) condition within six weeks before or after delivery. Results are shown overall; by state; and by four subpopulation topics: age group, race and ethnicity, disability-related eligibility category, and type of SMM condition (SMM category only). 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 ages 15 to 49 as of their delivery date, who were enrolled in Medicaid or CHIP at any point in the calendar year, and who had a live birth. Enrollees in Guam, American Samoa, the Northern Mariana Islands, and select states with TAF data quality issues are not included. Results shown for the race and ethnicity subpopulation topic exclude enrollees in the U.S. Virgin Islands. Results for SMM are calculated per 10,000 Medicaid- and CHIP-covered live births. 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: "Prematurity and severe maternal morbidity among Medicaid- and CHIP-covered live births in 2021." Preterm birth is defined as a live birth that occurs before the 37th week of gestation. SMM deliveries are defined as live births with an SMM condition within six weeks before or after delivery (Identifying Severe Maternal Morbidity (SMM)). Enrollees are assigned to an age group subpopulation using age as of their delivery date. 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 a disability category subpopulation using their latest reported eligibility group code and age in the year (Medicaid enrollees who qualify for benefits based on disability in 2020). 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.

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The Patient Protection and Affordable Care Act (ACA) relies heavily on the expansion of Medicaid eligibility to cover uninsured populations. In February 2008, Wisconsin expanded and reformed its Medicaid CHIP program and, as part of program implementation, automatically enrolled a set of newly eligible parents and children. This process of auto enrollment targeted newly eligible parents and older children whose children siblings were already enrolled in the states Medicaid CHIP program. Auto enrollment brought over 44,000 individuals into the program, representing more than 60 percent of all enrollees in the first month of the reformed program. Individuals who were auto enrolled were modestly more likely to leave the program relative to other individuals who enrolled in February 2008, unless their incomes were high enough to be required to pay premiums. These auto enrollees were much more likely to exit relative to other enrollees subject to premium payments. The higher exit rates exhibited by non premium paying auto enrollees were likely due to the fact that over 40 percent of auto enrollees were covered by a private insurance policy in the month of their enrollment, compared to approximately 30 percent for regular enrollees. A national simulation of an auto enrollment process similar to Wisconsins, including the expansion of adult Medicaid eligibility to 133 percent of the federal poverty level under the ACA, suggests that 2.5 million of the 5.6 million newly eligible parents could be auto enrolled, and approximately 25 percent of this population would be privately insured. These results suggest that auto enrollment may be appropriate for other states, especially in their efforts to enroll eligible populations who are not subject to premium requirements.

The Patient Protection and Affordable Care Act (ACA) relies heavily on the expansion of Medicaid eligibility to cover uninsured populations. In February 2008, Wisconsin expanded and reformed its Medicaid CHIP program and, as part of program implementation, automatically enrolled a set of newly eligible parents and children. This process of auto enrollment targeted newly eligible parents and older children whose children siblings were already enrolled in the states Medicaid CHIP program. Auto enrollment brought over 44,000 individuals into the program, representing more than 60 percent of all enrollees in the first month of the reformed program. Individuals who were auto enrolled were modestly more likely to leave the program relative to other individuals who enrolled in February 2008, unless their incomes were high enough to be required to pay premiums. These auto enrollees were much more likely to exit relative to other enrollees subject to premium payments. The higher exit rates exhibited by non premium paying auto enrollees were likely due to the fact that over 40 percent of auto enrollees were covered by a private insurance policy in the month of their enrollment, compared to approximately 30 percent for regular enrollees. A national simulation of an auto enrollment process similar to Wisconsins, including the expansion of adult Medicaid eligibility to 133 percent of the federal poverty level under the ACA, suggests that 2.5 million of the 5.6 million newly eligible parents could be auto enrolled, and approximately 25 percent of this population would be privately insured. These results suggest that auto enrollment may be appropriate for other states, especially in their efforts to enroll eligible populations who are not subject to premium requirements.

This dataset contains Potentially Avoidable Antibiotic Prescribing observed and risk-adjusted rates for child Medicaid enrollees by provider county beginning in 2010.

Potentially Avoidable Antibiotic Prescriptions are antibiotic prescriptions filled for the treatment of acute respiratory infections for which antibiotics are not indicated, contributing to bacterial drug resistance. Index visits for acute respiratory infections and corresponding prescription fills were identified through the use of previously published methods.

The rates were calculated using Medicaid outpatient claims and encounters, and prescription drug data.

The observed and risk adjusted rates are presented by provider county (including a statewide total).