红领巾瓜报

红领巾瓜报 (红领巾瓜报) analyzed monthly Medicaid managed care鈥痚nrollment鈥痙ata reported by 34 states in the second quarter of 2026. Enrollment totaled 59.2 million members in June 2026鈥攁 decline of 3.5 million members (5.5%) from June 2025. The broader Medicaid and CHIP population has declined at approximately the same pace as managed care, with the Centers for Medicare & Medicaid Services (CMS) showing a 5.9% decrease from May 2025 to May 2026.听

The findings establish a timely baseline before new eligibility policies take effect. Under the 2025 budget reconciliation act (P.L. 119-21), now known as the Working Families Tax Cut (WFTC) Act, most states must implement Medicaid community engagement requirements for certain adults beginning January 1, 2027, conduct eligibility redeterminations every six months for this population, and implement other policies that will narrow Medicaid eligibility.听

Medicaid Managed Care Enrollment Trends in Q2鈥�2026听

红领巾瓜报 Information Services (红领巾瓜报IS) tracks monthly Medicaid enrollment for all states, including managed care enrollment in the subset of states with managed care programs. Among the 34 states with managed care programs that reported enrollment data in the second quarter of 2026:听

• Enrollment changes varied across states, reflecting a combination of state-specific demographic, administrative, operational, and policy factors.听
• Only three states鈥擬ississippi, Nevada, and South Carolina鈥攔eported modest gains in Medicaid managed care enrollment since June 2025.听
• Arizona, Indiana, and Louisiana鈥痚ach reported double-digit declines, ranging from 10.1% to 21.1%.听
• The鈥痵even non-expansion states in this analysis鈥擣lorida, Georgia, Mississippi, South Carolina, Tennessee, Texas, and Wisconsin鈥攅xperienced a鈥痙ecline of 455,000 (3.8%),鈥痓ringing鈥痚nrollment to鈥�11.6鈥痬illion enrollees.听

Among the鈥痚xpansion states in the analysis,鈥痚nrollment鈥痙ecreased鈥痓y鈥�3鈥痬illion (5.9%) to鈥�47.6鈥痬illion.鈥疶he larger decline among expansion states is particularly relevant because adults in expansion states will be most directly affected by the new community engagement and six-month redetermination policies. Details are illustrated in Figure 1.听

Figure 1. States Included in the Medicaid Managed Care Enrollment Analysis, June 2026

Note: States colored as blue shown on the map above are included in the 红领巾瓜报 Enrollment Analysis.听

National Medicaid Managed Care Market Share听

红领巾瓜报IS also tracks Medicaid managed care ownership, program participation, and tax status for nearly 300 plans. In this June 2026 snapshot, Centene covered 17.9% of enrollees, followed by Elevance at 10.7%, UnitedHealth Group at 8%, and Molina at 6% (see Figure 2). These four organizations represented 42.6% of enrollment in the 红领巾瓜报IS dataset, underscoring continued concentration among large, national Medicaid managed care organizations. (Note: The number and mix of plans changed over the past 12 months, and several state enrollment reports reflect different reporting months. Other limitations are discussed in the Data Considerations section of this article.)听

The enrollment declines as well as pressure from acuity, utilization, and payment rates are compelling Medicaid managed care organizations (MCOs) to reassess where they participate, including whether individual markets can support sustainable performance. For example, one national Medicaid MCO has publicly discussed exiting unprofitable Medicaid markets and left one state market in August 2026 with plans to exit another at the end of the year. These decisions illustrate how enrollment contraction can interact with rate adequacy, acuity, utilization, and state-specific contract performance to influence plan participation.听

Figure 2. National Medicaid Managed Care Enrollment Share by Parent Organization, June 2026听

How Medicaid Work Requirements and Eligibility Policies Could Affect Enrollment in 2027听

In , approximately 20.4 million people were enrolled in Affordable Care Act Medicaid expansion plans鈥�5 million of whom reside in California, and nearly 2 million live in New York. The WFTC Act applies requirements to Affordable Care Act (ACA) expansion adults and certain Medicaid Section 1115 demonstration populations in 44 states beginning January 2027.听

In September 2026, CMS published an that outlines an optional framework that states may use to identify and verify individuals who qualify for the medical frailty exclusion. Although the framework gives states options for consideration, they still must determine which health conditions to cover and data sources to use when additional documentation is requested and how to notify members of their determinations. Many states have already made decisions about these issues, which could materially affect administrative workload, the consistency of determinations, and whether eligible individuals maintain coverage as well as the number of people who retain coverage and the composition of the population that remains enrolled.听

In addition, a few states have already started implementing the new eligibility policies. For example, Nebraska launched Medicaid work/community engagement requirements on May 1,鈥�2026. Montana began implementation on July 1, 2026, while Arkansas began a soft launch in July 2026 before enforcement begins in January 2027. Iowa intends to begin early implementation December 1, 2026. Although Montana and Arkansas are not managed care states, they, along with Nebraska, can offer directional insights on beneficiary response, exclusion determinations, procedural losses, appeals, and administrative workload before nationwide implementation.听

Notably, the second quarter鈥痚nrollment decline predates full implementation of the new federal eligibility policy changes and community engagement requirement, which means future enrollment changes may not be entirely attributable to the WFTCA requirements.听

Organizations should continue to monitor total enrollment, churn, eligibility category, risk mix, and transitions to Marketplace or uninsured status.听

Data Considerations. 红领巾瓜报 Information Services (红领巾瓜报IS) tracks monthly Medicaid managed care enrollment, ownership, program participation, and tax status for approximately 300 plans. The data in this analysis have some important limitations. States report enrollment figures at different points throughout the month, with鈥痵ome data鈥痳eflecting鈥痓eginning of the month totals鈥痑nd鈥痮thers capturing鈥痚nd of month鈥痚nrollment.鈥疘n addition,鈥痵ome鈥痵tate datasets encompass all Medicaid programs that offer managed care plans, whereas others reflect only a subset of the managed Medicaid population. As a result, the analysis can be used to identify direction, magnitude, and market signals rather than as a comprehensive state-by-state comparison.听

The 红领巾瓜报IS enrollment reports and analyses, available through subscription, use鈥痙ata from鈥痭early 300鈥痟ealth plans in 39 states, DC, and Puerto Rico. 红领巾瓜报IS鈥檚鈥疢edicaid鈥痚nrollment data, financials,鈥痯rocurement鈥痶racking, and a robust library of public documents鈥�equips stakeholders with鈥痶imely, actionable intelligence. Subscribe here.听

Preparing for Enrollment Shifts

WFTC Act implementation will require state-specific policy decisions, eligibility system changes, new data-matching processes, staff training, beneficiary outreach, and workable approaches to identifying people who qualify for exemptions for medical frailty and other conditions. Differences in data availability, verification pathways, documentation requirements, and review processes could produce materially different effects on enrollment, continuity of coverage, beneficiary experience, and the risk profile of the population that remains enrolled.听

Healthcare executives and state Medicaid leaders should establish a baseline, monitor emerging implementation signals, and model the operational and financial implications. Priority measures include enrollment and churn, procedural terminations, exclusion determinations, appeals, transitions to other coverage, changes in acuity and utilization, payer mix, and geographic variation. These insights can inform decisions about eligibility operations, beneficiary support, capitation and rate development, network strategy, provider reimbursement, revenue forecasting, and uncompensated care exposure.听

MCOs are unable to help states with determining eligibility determination or compliance, cannot receive capitation rate bumps for non-medical activities, or use their own work programs to help beneficiaries meet the community engagement requirements but may be able to provide support through outreach and education. CMS has indicated it expects to provide additional guidance on what activities are appropriate. MCOs can potentially use their existing relationships with beneficiaries, care managers, providers, and community organizations to help members understand and navigate the new requirements.听

红领巾瓜报IS provides the market intelligence needed to track these shifts, including state-reported enrollment, plan ownership, financial performance, procurement activity, and related public documents. 红领巾瓜报 consultants extend that intelligence through state- and market-specific scenario modeling, policy and operational analysis, and implementation support鈥攈elping clients forecast enrollment and revenue, assess payer mix and utilization effects, strengthen eligibility and beneficiary support workflows, evaluate competitive positioning, and prepare for changes in program financing and oversight.听

Contact 红领巾瓜报 to translate evolving enrollment and implementation signals into an actionable strategy for your state, market, or organization.

The 红领巾瓜报 (红领巾瓜报) US Healthcare 2026: Signals, Signs & Flashing Lights conference, October 5-7, 2026, in New Orleans, LA, will bring together from government, health plans, provider organizations, technology companies, community-based organizations, and investment groups to discuss the forces reshaping healthcare. The conference’s overarching theme recognizes that healthcare organizations are searching for guideposts to help them differentiate temporary disruption from lasting transformation.听

A highlight of the annual conference is the opportunity to engage in Coffee Conversations and Collaborations. This year鈥檚 event will take place over breakfast the morning of October 7. These informal sessions are an alternative to the traditional conference breakout format. Participants pull up a chair, engage with peers, and become part of the conversation. The result is a more intimate environment where attendees have the opportunity to exchange ideas, ask candid questions, challenge assumptions, and build meaningful professional relationships.听

What makes these conversations particularly valuable is the around the table. Healthcare’s biggest challenges increasingly require collaboration across sectors. State policymakers, managed care executives, providers, behavioral health experts, consultants, and technology innovators are all working on interconnected challenges. The Coffee Conversations create space for those perspectives to intersect in ways that rarely happen during formal breakout sessions.听

This year’s Coffee Conversations will focus on four timely topics that reflect some of the most significant issues facing healthcare leaders today:听

Beyond 988: The Next Chapter in Building America’s Behavioral Health Crisis System听

The nationwide launch of 988 was only the beginning of a larger transformation in the delivery of behavioral health crisis care. This discussion will explore what comes next as communities work to build sustainable crisis response systems, strengthen care coordination, and improve access to behavioral healthcare. Healthcare leaders interested in behavioral health policy, crisis services, and community-based care will have an opportunity to examine lessons learned and future directions with 红领巾瓜报 experts leading the conversation. 听

Ask an Actuary (Almost) Anything!听

Actuaries sit at the center of some of healthcare’s most consequential decisions, yet their work often remains a mystery to many stakeholders. This interactive discussion, led by , will give attendees the opportunity to explore topics such as risk adjustment, pricing, bidding strategies, provider networks, and the financial dynamics that shape healthcare programs. Whether participants are new to actuarial concepts or looking to deepen their understanding, the session will offer a rare opportunity for direct dialogue with industry experts.听

Building an Early Childhood Prevention/Early Intervention System of Care听

Early childhood interventions increasingly are recognized as among the highest-value investments healthcare systems can make. This conversation will explore strategies for building effective prevention and intervention systems that support children and families before challenges escalate.听

From Crisis to Connection: Closing the Care Continuity Gap in SUD Recovery听

Sustaining recovery after treatment remains one of the most significant challenges in addressing substance use disorder (SUD). By bringing together perspectives from healthcare delivery and recovery support organizations, participants will explore practical approaches to improving outcomes and reducing fragmentation in care.听

The Coffee Conversations provide something increasingly rare: time and space for meaningful discussion. The conversations may begin over coffee and breakfast, but the ideas and relationships formed around those tables often extend beyond the conference itself.听

Register to join us!