Survey finds Medicaid enrollment fell in FY 2025, expects flattening in 2026, while spending increases  

Medicaid enrollment decreased 7.6% in fiscal year 2025 and is expected to be mostly flat in FY 2026, according to KFF’s annual Medicaid Budget Survey released today. Meanwhile, total Medicaid spending increased 8.6% in FY 2025 and is projected to grow 7.9% in FY 2026. States cited provider rate increases, greater enrollee health care needs, and growing costs for long-term care, pharmacy benefits and behavioral health services as key drivers of increased costs. Nearly two-thirds of states said they have at least a “50-50” chance of a Medicaid budget shortfall in FY 2026 as they expect tighter fiscal conditions. The report said that states are facing uncertainty in their long-term fiscal outlook due to slowing revenues, rising costs, and changes in economic conditions and federal policy.