The current Medicaid enrollment across the United States
As of 2024, roughly 72 to 75 million people are enrolled in Medicaid across all 50 states, though the exact number shifts month to month as people gain and lose coverage. This includes children, pregnant people, parents, seniors, and people with disabilities. The number has been declining since late 2023, when the federal government ended the continuous enrollment period that had kept people on the rolls during the pandemic — states have since been reviewing cases and removing people who no longer meet the rules.
Medicaid enrollment varies dramatically by state. California, Texas, and New York each cover more than 5 million people. Wyoming, Vermont, and Alaska each cover fewer than 200,000. These differences reflect both population size and how generously each state sets its income limits and coverage rules.
The enrollment number you see reported depends on when it was counted and which states reported on time. Federal data lags by several months, so news stories about "current" enrollment are usually reporting figures that are already three to six months old.
Key Takeaways
- Medicaid covers approximately 72 to 75 million people in the United States as of 2024, but this number changes constantly as people gain and lose coverage each month.
- Enrollment dropped significantly starting in late 2023 when the federal government ended pandemic-era rules that had kept people on Medicaid automatically.
- The number of people on Medicaid in your state depends on that state's income limits, rules about who qualifies, and how aggressively it reviews cases.
- Published enrollment figures are typically several months old because states report data on different schedules and federal agencies take time to compile it.
Why enrollment numbers changed so much between 2020 and 2024
During the COVID-19 pandemic, the federal government passed a rule that prevented states from removing people from Medicaid, even if their circumstances changed. This rule kept enrollment artificially high — people who would normally have lost coverage stayed on the rolls. By early 2023, Medicaid enrollment had peaked at around 80 to 81 million people.
In April 2023, that continuous enrollment period ended. States were allowed to resume their normal process of reviewing cases and removing people who no longer met the rules. This process, called "disenrollment" or "unwinding," has been happening gradually across all states since then. Some states moved quickly; others moved slowly. By mid-2024, enrollment had fallen to the 72 to 75 million range.
Not everyone who lost Medicaid during this period was ineligible. Some people simply did not respond to notices, moved without updating their address, or did not understand they needed to renew. Other people genuinely no longer may have access to because their income had risen or their family situation had changed.
How enrollment breaks down by category
Medicaid covers several distinct groups, though the exact breakdown varies by state. Children make up the largest single group — roughly 28 to 30 million children are on Medicaid. Parents and caretakers account for another 15 to 17 million. Seniors (people 65 and older) on Medicaid number around 7 to 8 million, though many seniors are also on Medicare. People with disabilities represent roughly 8 to 10 million of the total.
These categories overlap in some cases. A person can be both a parent and disabled, or both a senior and blind. States count people in the category that determines their Medicaid coverage, so the same person might appear in different categories depending on which rule made them may be able to access.
The "expansion" population — people who became newly may be able to access for Medicaid when states expanded the program under the Affordable Care Act — makes up roughly 15 to 18 million people. Not all states have expanded Medicaid; 10 states have not, which means millions of people in those states fall into a coverage gap where they earn too much for traditional Medicaid but too little for marketplace insurance subsidies.
State-by-state variation in enrollment
Medicaid enrollment is not evenly distributed. The 10 largest states by Medicaid enrollment account for roughly 40 percent of all people on the program. California alone covers about 10 percent of all Medicaid beneficiaries in the country.
States that expanded Medicaid under the Affordable Care Act generally have higher enrollment rates than states that did not. Expansion states cover a broader income range, so more people may have access to. Non-expansion states cover only certain categories — primarily children, pregnant people, parents with very low incomes, seniors, and people with disabilities — which means fewer people overall are covered.
State rules about what counts as income, what assets you can have, and how often you must renew also affect enrollment. A state with generous rules and easy renewal processes will have higher enrollment than a state with strict rules and frequent paperwork requirements, even if both states serve the same population.
How the enrollment number is tracked and reported
The Centers for Medicare and Medicaid Services (CMS), a federal agency, collects enrollment data from all 50 states and publishes it monthly. However, states report on different schedules and with different delays. Some states report their numbers within a few weeks; others take two or three months. CMS publishes a preliminary report each month and then revises it as more states submit their data.
This means any enrollment figure you see in the news is a snapshot from a specific month, not a real-time count. If you read that "Medicaid enrollment is 73 million," that figure is probably from two to four months before the article was published.
Different organizations also report enrollment numbers slightly differently depending on which states they include, which month they use, and whether they count people who are enrolled but not actively using services. This is why you might see different numbers from different sources — they are often measuring slightly different things.
What happens to people who lose Medicaid coverage
When someone loses Medicaid during the unwinding process, they do not automatically gain coverage elsewhere. Some people become uninsured. Others move to employer coverage if they have a job that offers it. Some people become may be able to access for marketplace insurance through Healthcare.gov and may receive subsidies based on their income.
States are required to notify people before removing them from Medicaid, usually by mail. If you receive a notice that you are being removed, you have the right to request a hearing to challenge the decision. You can also reapply if your circumstances change or if you believe the state made an error.
Some states have set up programs to help people transition from Medicaid to other coverage. Others have extended their unwinding process to give people more time to respond to notices. The speed and generosity of this transition varies significantly by state.
Frequently Asked Questions
Is the Medicaid enrollment number still dropping?
The rate of decline has slowed since 2023, but enrollment continues to shift as states complete their case reviews. Some states have finished unwinding; others are still in the process. The overall trend has been downward, but the pace varies by month and by state.
Why do different news sources report different Medicaid enrollment numbers?
Different sources use data from different months, count different groups, or include different states. Some reports include only people actively using services; others count everyone enrolled. Always check the date and source of the data to understand what period it covers.
If I lost Medicaid, can I get it back?
Yes. You can reapply at any time if your income has dropped, your family situation has changed, or if you believe the state made an error when removing you. Contact your state Medicaid office or visit your state's Medicaid website to start the process.
Does Medicaid enrollment include people on Medicare?
Some people are on both Medicaid and Medicare — these people are called "dual may be able to access." They are counted in Medicaid enrollment figures. However, the total Medicaid enrollment number does not represent 72 million unique people, because some individuals may be counted in multiple categories or have overlapping coverage.