Third Quarter 2023 Medicaid Enrollment Tumbles Following End of Protections


February 8, 2024



As of September 30, 2023 (3Q23), total Medicaid enrollment included nearly 85.8 million Americans, representing a year-over-year (YOY) decrease of over 2.2 million enrollees (-2.5%) since the same time the previous year (3Q22). This decrease in enrollment is primarily due to the conclusion of the public health emergency (PHE) on March 31, 2023, when many state health departments initiated “unwinding” plans of renewals and redetermination. When just comparing 3Q23 to 2Q23, enrollment fell by almost 4 million (-4.4%).

  • With the largest Medicaid enrollment by a significant margin, California was one of only thirteen states with a year-over-year (YOY) increase in Medicaid enrollment, even with a negative quarterly change. Despite losing nearly 255,000 enrollees from 2Q23 to 3Q23, California still maintained a net YOY increase of over 716,000 covered lives.
  • Texas and Florida Medicaid saw significant declines in YOY enrollment, losing over 487,000 (-9.3%) and 552,000 (-11.8%) members, respectively. Most of this decline for Texas occurred in 3Q23, as its quarterly decrease in members was nearly 476,000, over 86,000 of which were from Harris County, home to Houston. Meanwhile, Florida, in the same quarter, dropped by over 311,000, losing nearly 48,000 enrollees in just Miami-Dade County.
  • In terms of percentages, Alaska saw the single largest quarterly decrease in enrollment, with 18.9% of its members losing coverage, representing just under 50,000 covered lives. Montana saw a 15.1% drop in quarterly enrollment, losing over 44,000 enrollees. For notable annual callouts, Idaho saw a YOY decrease of 26.7% (about 115,000 members) and New Hampshire saw a decline of 25.2% (61,000 members).
  • While many states saw significant membership decreases throughout the year, a few states did see slight bumps in membership. Oregon, despite losing about 5,000 members over the quarter, had a YOY increase of over 120,000, or about 9%. Nevada and Hawaii both experienced notable quarterly increases, with Nevada gaining 5.5% in membership (over 43,000 enrollees) and Hawaii seeing a 5.8% increase (25,000 enrollees).

With the public health emergency (PHE) and the federal government’s continuous Medicaid coverage requirement concluded, the renewals and redeterminations have had a tremendous impact on Medicaid enrollment across the nation. Evaluating market share in response to these changing laws and redeterminations will be an important measure of competitive positioning and health plan performance for insurers.

Mark Farrah Associates will continue to monitor enrollment across the country, using County Health CoverageTM and integrating highly relevant sources to provide reliable estimates of health insurance 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 Private Risk, Private Administrative Services Only (ASO), 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 informational videos and brochures available under the Our Products section of the website or call 724-338-4100.

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