States project flat Medicaid enrollment, increased spending as cuts loom: KFF

Dive Brief:

Medicaid enrollment declined this year as states ended pandemic-era continuous enrollment policies, but spending rose — and looming cuts to the safety-net insurance program means more cost pressures are on the horizon, according to a report published Thursday by KFF.

Enrollment fell 7.6% in fiscal year 2025, and it’s expected to be largely flat in fiscal year 2026, according to the survey of state Medicaid directors. Meanwhile, total spending grew by 8.6% in 2025, and costs are projected to grow by 7.9% in 2026.

Provider rate hikes and greater health needs among beneficiaries alongside rising costs for long-term care, pharmacy benefits and behavioral healthcare are the biggest drivers of increased spending, states said.

Dive Insight:

State Medicaid programs are managing