Jeffrey Wade
Medicaid is a major source of funding for hospitals, community health centres, physicians, and nursing homes. It provides health and long-term care coverage to almost 82 million low-income individuals, including children, pregnant women, adults, seniors, and people with disabilities in the United States. In 2022, 18.8% of the population was covered by Medicaid, making it the second most common type of health insurance coverage after employment-based insurance. As of November 2024, 79,034,066 people were enrolled in Medicaid and CHIP across the 50 states and the District of Columbia.
| Characteristics | Values |
|---|---|
| Total number of people enrolled in Medicaid and CHIP in the US | 79,034,066 |
| Percentage of the population covered by Medicaid | 18.9% |
| Number of children enrolled in Medicaid and CHIP | 37,517,916 |
| Percentage of total Medicaid and CHIP enrollment comprised of children | 47.5% |
| Number of people enrolled in Medicaid in North Carolina | 610,000 |
| Percentage increase in Medicaid enrollment in North Carolina since 2020 | 47% |
| Percentage increase in Medicaid enrollment in Nebraska, Oklahoma, Missouri, Maine, and South Dakota | 20% or more |
| Percentage of non-elderly Medicaid enrollees who are people of color | N/A |
| Percentage of adult Medicaid enrollees who are working | N/A |
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What You'll Learn
Medicaid enrollee demographics
The Children's Health Insurance Program (CHIP), introduced in 1997, provides low-cost health coverage for children under the age of 19 in families that earn too much to qualify for Medicaid but insufficient to purchase private insurance. CHIP eligibility limits and coverage vary by state, with some states also extending coverage to pregnant individuals with low incomes. As of November 2024, approximately 37.5 million children were enrolled in CHIP or the Medicaid program, representing 47.5% of total Medicaid and CHIP enrollment.
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Medicaid funding sources
Medicaid and the Children's Health Insurance Program (CHIP) provide health and long-term care coverage to almost 82 million low-income children, pregnant women, adults, seniors, and people with disabilities in the United States. According to more recent data, 79,034,066 people were enrolled in Medicaid and CHIP in the 50 states and the District of Columbia that reported enrollment data for November 2024. Medicaid is a major source of federal financing for costs that would otherwise be borne by state and local governments, individuals paying out of pocket, and providers supplying care at free or reduced rates.
Medicaid spending totaled $880 billion in FFY 2023, with the federal government paying 69% ($606 billion) and states paying 31% ($274 billion). This share is slightly higher than historical shares due to the enhanced pandemic match rate, but there is variation across states. The federal share of Medicaid spending was 65% nationally in fiscal year (FY) 2019. The federal share for most Medicaid service costs is determined by the federal medical assistance percentage (FMAP), which is based on a formula that provides higher reimbursement to states with lower per capita incomes relative to the national average. FMAPs have a statutory minimum of 50% and maximum of 83%.
While the traditional FMAP applies to most Medicaid spending, there are exceptions that provide higher match rates for specific services or populations, such as family planning and, most notably, people covered under the ACA Medicaid expansion. States that have implemented the expansion currently receive a 90% FMAP for adults covered through the ACA Medicaid expansion. Administrative costs incurred by states are usually matched by the federal government at a 50% rate, but some functions, such as eligibility and enrollment systems, receive higher match rates. Medicaid administrative costs are less than 4% of total Medicaid spending.
Medicaid is a significant expenditure item and the largest source of federal revenues for state budgets. In the state fiscal year (SFY) 2023, Medicaid accounted for 30% of total state spending for all items in the budget. Medicaid accounted for only 15% of expenditures from state funds (including state general funds and other state funds) and 57% of all expenditures from federal funds. States have an incentive to control Medicaid spending because they pay a share of the costs, but research shows that federal matching dollars from Medicaid spending have positive effects on state economies.
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Medicaid coverage
Medicaid is a federal and state program that provides health care coverage to people who qualify. Each state runs its own Medicaid program within federal standards, but the federal government has rules that all states must follow. The federal government also provides at least half of the funding for their Medicaid requirements.
Medicaid and the Children's Health Insurance Program (CHIP) provide health and long-term care coverage to almost 82 million low-income children, pregnant women, adults, seniors, and people with disabilities in the United States. Some sources state that 76.4 million or 79 million individuals are enrolled in Medicaid and CHIP.
Medicaid programs serve specific groups of people, including:
- Low-income people, families, and children
- Pregnant people
- The elderly
- People with disabilities
States can also choose to expand eligibility to other groups, such as people with low incomes who may or may not have children. With Medicaid, there may be several types of low-cost or no-cost plans available, depending on the state where you live.
Mandatory benefits under Medicaid include services such as inpatient and outpatient hospital services, physician services, laboratory and x-ray services, and home health services. Optional benefits include services such as prescription drugs, case management, physical therapy, and occupational therapy.
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Medicaid eligibility
Medicaid is a federal-state program that provides health coverage to over 77.9 million Americans. It is the largest source of health coverage in the United States. Eligibility for Medicaid is based on income and family size, and rules differ among states. In general, Medicaid covers some individuals and families, including children, parents, pregnant women, seniors, and individuals with disabilities.
To participate in Medicaid, federal law requires states to cover certain groups. Low-income families, qualified pregnant women and children, and individuals receiving Supplemental Security Income (SSI) are examples of mandatory eligibility groups. States have additional options for coverage and may choose to cover other groups, such as individuals receiving home and community-based services and children in foster care.
The Affordable Care Act of 2010 allowed states to expand Medicaid to cover nearly all low-income Americans under 65. Eligibility for children was extended to at least 133% of the federal poverty level (FPL) in every state, and states were given the option to extend eligibility to adults with incomes at or below 133% of the FPL. Most states have chosen to expand coverage to adults, and those that have not yet expanded may do so at any time.
Eligibility for Medicaid is determined using Modified Adjusted Gross Income (MAGI), which replaced the former process based on the Aid to Families with Dependent Children program that ended in 1996. MAGI considers taxable income and tax filing relationships to determine financial eligibility. Some individuals are exempt from the MAGI-based income counting rules, including those whose eligibility is based on blindness, disability, or age (65 and older).
In Connecticut, for example, residents who are 65 or older, blind, or disabled may qualify for Medicaid coverage under HUSKY C. Income and asset eligibility vary depending on the specific program. Similarly, North Carolina has expanded Medicaid coverage to include people ages 19-64.
It is important to note that not every medical provider accepts Medicaid. To locate a Medicaid provider, individuals should check with their state's Medicaid agency, as each state has its own requirements and programs.
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CHIP enrollee demographics
As of November 2024, 79,034,066 people were enrolled in Medicaid and CHIP across the 50 states and the District of Columbia that reported enrollment data. This data is collected by the Centers for Medicare & Medicaid Services (CMS) and includes eligible individuals who are enrolled in comprehensive benefits programs.
Regarding CHIP enrollee demographics, the Children's Health Insurance Program (CHIP) serves millions of children in the United States. While specific demographic data for CHIP enrollees is not readily available, we can look at some indicators and related data. CHIP is designed for children in families with incomes too high to qualify for Medicaid but who cannot afford private insurance. This suggests that CHIP enrollees tend to come from low- to moderate-income families.
State-level data on CHIP enrollment varies, with each state defining "child" differently for reporting performance indicator data to CMS. For example, the most recent published SEDS annual enrollment report showed CHIP enrollment of more than 9.6 million. This figure represents a point-in-time count of total program enrollment and not solely those newly enrolled during the reporting period.
Additionally, it is worth noting that CHIP is a state-operated program, and eligibility criteria can vary across states. All states, including the District of Columbia, are required to provide data to CMS on a range of indicators related to CHIP application, eligibility, and enrollment processes. This data includes information on enrollment numbers, eligibility criteria, and other key indicators, which can provide further insights into the demographics of CHIP enrollees at a state level.
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Frequently asked questions
As of November 2024, 79,034,066 people were enrolled in Medicaid and CHIP across the 50 states and the District of Columbia. This number represents a point-in-time count of total program enrollment and includes only those eligible for comprehensive benefits.
As of 2023, Medicaid was the second most common form of health insurance coverage in the United States, covering 18.9% of the population. This places it behind employment-based insurance (53.7%) and ahead of Medicare (also 18.9%).
Medicaid provides health and long-term care coverage to low-income children, pregnant women, adults, seniors, and people with disabilities.
