CMS posts January 2026 Medicaid/CHIP enrollment report: 75.3M, down 4.2M since December 2024

Sat, 04/25/2026 - 11:53am

The Trump Regime has published an update to the official Medicaid/CHIP enrollment data:

January 2026 Key Findings

Medicaid and CHIP Enrollment

In January 2026, 75.3 million individuals were enrolled in Medicaid and CHIP.

68.0 million individuals were enrolled in Medicaid, and 7.2 million individuals were enrolled in CHIP.

39.4 million adults were enrolled in Medicaid, and there were 35.9 million Medicaid child and CHIP enrollees.

Total Medicaid/CHIP enrollment in December 2025 dropped about 1.3% from December 2025, or by around 943,000 people.

The all-time high enrollment watermark for Medicaid/CHIP was in April 2023, when it officially hit 94.1 million Americans (95.7 million when you include the U.S. territories).

It's important to note that CMS actually has two different reports on Medicaid enrollment: The monthly Medicaid & CHIP Enrollment Trend Snapshot (referenced above) and the Medicaid Budget & Expenditure System (MBES).

Each type of report measures Medicaid enrollment a bit differently:

The MBES report is 10 months out of date (through June 2025) while the Trend Snapshot is only 3 months out of date (through January 2026).

The MBES count includes individuals enrolled in limited benefit plans and the Performance Indicator count does not include such individuals.

The MBES data represents the count of unduplicated individuals enrolled in the state’s Medicaid program at any time during each month in the quarterly reporting period, while the Performance Indicator data captures the count of individuals enrolled on the last day of the month.

The MBES count only includes individuals whose coverage is funded through Medicaid (title XIX of the Social Security Act), while the published Performance Indicator also includes individuals funded through CHIP (title XXI of the SSA).

MBES and Performance Indicator data may be derived from different state systems.

Retroactive state adjustments to MBES or Performance Indicator data may be in progress.

States have likely generated MBES data and Performance Indicator data from state systems on different dates.

The other major difference: The MBES reports include Medicaid enrollees in the U.S. territories: American Samoa, Guam, N. Mariana Islands, Puerto Rico and the U.S. Virgin Islands.

The MBES numbers for U.S. territories stood at 1.44 million Medicaid enrollees as of June 2025. If you add those to the Trend Snapshot total for the 50 states +DC, it comes in at 76.7 million as of January 2026.

It's also worth noting that ACA Medicaid Expansion enrollment specifically was 20.4 million as of June 2025 according to the MBES report, down around 3.6 million from the all-time high it reached in May 2023.

There's one other important data point missing from the January CMS Medicaid/CHIP enrollment snapshot:

Until now, the summary report also included a brief mention of total effectuated ACA marketplace enrollment in Qualified Health Plans (QHPs), rounded off to the nearest 100,000. As of December effectuated enrollment was ~21.8 million people.

However, starting this month, this data point is missing...and that's not by accident; it includes this footnote:

As of the January 2026 data, Marketplace enrollment data are no longer included in this report but will be available separately soon.

Given the massive drop-off in effectuated enrollment which I've been warning about for months and which is starting to trickle out via individual state-based exchange reports, I suppose this shouldn't be surprising...