CMS Posts January 2026 Medicaid/CHIP Enrollment Report: 75.3M, Down 4.2M Since December 2024

Key Takeaways

• Medicaid/CHIP enrollment at 75.3 M in Jan 2026, 5.3% below Dec 2024
• Adult Medicaid enrollment 39.4 M; child/CHIP enrollment 35.9 M
• Enrollment dropped 943 k from Dec 2025, first decline since 2023 peak
• MBES data including territories shows 76.7 M, 1.44 M in territories
• Marketplace enrollment figures removed from report, to be released separately

Pulse Analysis

The latest CMS enrollment snapshot underscores a reversal from the pandemic‑era surge that pushed Medicaid and CHIP participation to a record 94.1 million in April 2023. A combination of tightened eligibility rules, work‑requirements in several states, and a slowdown in economic recovery has trimmed the rolls to 75.3 million, a 5.3% dip since the end of 2024. For health‑care providers and insurers, the contraction translates into fewer patients covered under low‑cost public programs, potentially reshaping payer mixes and reimbursement strategies.

Data users must navigate two parallel reporting streams: the monthly Trend Snapshot, which reflects end‑of‑month counts for the 50 states and DC, and the Medicaid Budget & Expenditure System (MBES), which lags by several months but includes limited‑benefit plans and U.S. territories. When the 1.44 million territorial enrollees are added, the national figure rises to 76.7 million, highlighting the importance of selecting the appropriate dataset for policy analysis and fiscal forecasting. The methodological differences—unduplicated monthly presence versus last‑day counts—can produce divergent trends, especially in states with frequent enrollment churn.

Beyond the raw numbers, the omission of marketplace enrollment data from the January report raises concerns about transparency in the broader health‑coverage landscape. As ACA exchange participation continues to wane, the lack of consolidated reporting hampers assessments of how private‑market shifts interact with public program enrollment. Stakeholders—from state budget officers to health‑policy advocates—will be watching for the forthcoming separate marketplace release to gauge the full impact of declining coverage on federal subsidies and state Medicaid funding formulas.