| |  | Agency alert | Medicaid enrollment dropped by 3.4 million people between January 2025 and January 2026, according to Centers for Medicare and Medicaid Services data released recently. That’s before most eligibility changes in President Donald Trump’s One Big Beautiful Bill Act take effect. That law is expected to lead to 10 million fewer people having Medicaid and Affordable Care Act coverage by 2034, according to the Congressional Budget Office. It will cut federal Medicaid spending by about $911 billion over a decade. Medicaid is the biggest federally funded health coverage program in America. A CMS spokesperson said in an email it is “important to consider long-standing program integrity challenges” that current agency initiatives are designed to fix. “Addressing these issues ensures coverage is accurate and taxpayer dollars are spent appropriately — not that eligible individuals are losing access to care,” said the spokesperson. Last summer, a CMS analysis of its 2024 data showed that more than 1 million people were enrolled in Medicaid in multiple states and about 1.6 million individuals were in both Medicaid and Affordable Care Act coverage. CMS officials did not specify how many of the people who left the Medicaid program last year had other coverage. By the numbers: About 75 million people were enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) in January, the most recent data available. Medicaid is the federal-state program for low-income people and those with disabilities. CHIP is largely for kids in families with slightly higher income than those in Medicaid. Closer look: The CMS data show several other factors influencing the decline. - The number of applications is down by about 8 percent during that year.
- Applications also are being processed more slowly than the 45 days usually allowed for people without disabilities. That’s particularly true in Alaska, where half of the applications are taking more than the usual 45 days; Wyoming, where 38 percent were taking longer; and Georgia, where 37 percent were taking longer.
- Renewal rates dropped steadily from 76 percent in May. In January, about 65 percent of people whose coverage was due for renewal were approved.
→ 15 percent of people trying to renew were disenrolled for unspecified “procedural reasons,” up from 10 percent earlier in 2025 → 5 percent were disenrolled because they were found ineligible → 15 percent were waiting on an answer Leading the change was Indiana. About 47 percent of renewals there were approved, according to CMS. The vast majority of the disapprovals were for unspecified procedural reasons. “Indiana increased Medicaid eligibility checks,” said an Indiana Family and Social Services Administration spokesperson by email. Health policy researchers say that they see indicators that fewer U.S. children have insurance compared to early last year. “For children we are seeing declines in every state since January 2025 except Minnesota,” said Joan Alker, executive director of the Georgetown Center for Children and Families. The enrollment of children in ACA marketplace insurance is not increasing, she said, “and private insurance for families is just becoming more expensive so a lot of these kids are probably becoming uninsured.” If people lose coverage, they sometimes face high bills. “Unfortunately for families any gap in coverage puts them at risk of financial pressure,” said Alker. “If a kid falls and breaks a bone on the playground or has an asthma attack and winds up in the ER, this can lead to crushing levels of medical debt.” Hospitals, other providers and health insurance plans can be affected when Medicaid enrollment declines. Looking ahead: States are preparing now for additional policy directives from Washington that will affect state finances. One rule is undergoing a final review by the Office of Management and Budget. | 
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