Medicaid Enrollment Continues Downward Shift in Third Quarter 2025
February 12, 2026
As of September 30, 2025 (3Q25), total Medicaid enrollment included 75.2 million Americans, representing a year-over-year (YOY) decrease of over 2.3 million enrollees (-3%) since the same time the previous year (3Q24). This decrease in enrollment is in part due to nationwide budget cuts to state health departments’ Medicaid programs. When comparing 3Q25 to 2Q25, enrollment fell by approximately 866,000 (-1.1%).
- With the largest Medicaid enrollment by a significant margin, California saw a year-over-year (YOY) decrease in Medicaid enrollment of over 115,000 (k), or about -0.8%. From 2Q25 to 3Q25, California saw a quarterly drop of almost 205k (-1.5%).
- New York, Texas, and Florida Medicaid saw significant declines in YOY enrollment, losing 156k (-2.6%), 43k (-1.1%), and 136k (-3.7%) members, respectively. The majority of these three states’ declines occurred prior to 2Q25, as their 2Q25-3Q25 quarterly shifts in members were much smaller: New York lost 60k quarter-to-quarter, a loss of -1%; meanwhile, Texas saw a quarterly drop of nearly 10k (-0.3%) and Florida saw a -0.7% drop of about 23k members.
- In terms of percentages, Alaska saw the single largest quarterly decrease in enrollment, with 7.7% of its members losing coverage, representing just over 17k covered lives. Indiana saw a 5.4% drop in quarterly enrollment, losing over 86k enrollees. For notable annual callouts, New Jersey saw a YOY decrease of -15.4% (over 302k members) and Arizona saw a decline of -11.7% (233k members).
- While nearly all states saw significant membership decreases throughout the year, a few states did see slight bumps in membership. Year-over-year, North Carolina and Colorado experienced moderate percentage growth, with North Carolina gaining 4.5% in membership (122k enrollees) and Colorado seeing a 2.1% increase (25k enrollees).
Budget cuts have had a tremendous impact on the Medicaid enrollment landscape across the nation. Though total membership continues to decline, the rate of that loss is slowing down. Evaluating market share in response to these changing metrics will be an important measure of competitive positioning and health plan performance for insurers.
County Health CoverageTM allows Mark Farrah Associates’ customers the ability to monitor county- and state-level Medicaid enrollment across the country; by integrating highly relevant sources it provides reliable estimates of health insurance coverage and carriers’ market share at these levels.
About County Health CoverageTM
County Health CoverageTM provides reliable estimates of health insurance enrollment and market share at the state, county, and Metropolitan Statistical Area (MSA) levels. Product features include company market share by county, company, and state for the Individual, Private Group Risk, Private Administrative Services Only (ASO), Managed Medicaid, Medicare Advantage, and stand-alone Prescription Drug Plan (PDP) segments. Breakdowns by product type (HMO, PPO, etc.) are also presented, as well as population demographics and interactive, visual mapping tools. To learn more, visit the product page - County Health CoverageTM.
About Mark Farrah Associates (MFA)
Mark Farrah Associates (MFA) is a leading data aggregator and publisher providing health plan market data and analysis tools for the healthcare industry. Our product portfolio includes Health Coverage Portal™, County Health Coverage™, Medicare Business Online™, Medicare Benefits Analyzer™, 5500 Employer Health PLUS, and Health Plans USA™. For more information about these products, refer to the product pages and brochures, available under the Our Products section of the website (www.markfarrah.com) or call 724-338-4100.
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