The Medicaid rolls declined by 7.5% in fiscal year 2024, the nonpartisan policy research group KFF reported this week in its annual survey of state Medicaid directors. The decline is expected to continue in 2025, with the number of participants projected to fall by another 4.4%.
The number of people receiving healthcare through Medicaid reached record highs during the Covid-19 pandemic, due in large part to an easing of the requirements for participation and a pause on routine disenrollments. Medicaid enrollment grew by 32% during the three-year emergency period, rising from 71.3 million to 94.1 million, according to data collected by KFF. But Congress required states to return to pre-Covid standards for participation starting in 2023, initiating a state-by-state process of disenrollment that has removed more than 10 million people from Medicaid coverage.
Although total spending has not fallen, spending growth has slowed as enrollment has declined. Total Medicaid spending rose 5.5% in 2024, down from a growth rate of 9.1% the year before. The growth rate is expected to slow further to 3.9% in 2025.
Looking ahead, KFF said that states are facing considerable uncertainty in determining what the new normal is for Medicaid spending and enrollment. “Adding to this uncertainty are the loss of pandemic-related enhanced federal funding, shifts in state fiscal conditions, and the upcoming election, all [of] which can have implications for Medicaid spending trends,” the report said.
