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It's been a while since we looked at the State Medicaid and CHIP Applications, Eligibility Determinations, and Enrollment Data numbers provided by Data.Medicaid.gov. I've been analyzing this data set for the past year (in posts here, here, and here) to get a handle on how many people are enrolling their children in the Children's Health Insurance Program (CHIP), and how political maneuverings at the state and federal levels have impacted (or may soon influence) those enrollment numbers.

I've included several graphs from a range of states at the end of this post, so if you're interested in seeing overall trends and want to start by jumping to the end of the post, please feel free to do so. I used publicly-available data sets available at Data.Medicaid.gov in my analysis, and (for anyone who might be reviewing this for certification purposes) I used both SQL and R programming to analyze the numbers and create the charts you'll find at the end of this blog post.

Let me say before we get going that the numbers on which I'm basing my analysis in this post are from September 2025, and they're slightly outdated. That's because during the course of writing this post, Medicaid released November numbers. So I decided that instead of chucking my charts, I'll plan to continue tracking CHIP enrollment trends and account for the November 2025 numbers in a later post.

As a reminder, in past posts I've chosen five states to highlight – Maine, Arizona, North Dakota, Kansas, and Colorado. I've done so because, to some degree, they represent the U.S. political spectrum: one of these states is reliably liberal (Maine), one is a swing state (Arizona), and two are reliably conservative states (North Dakota and Kansas). I also included Colorado because, like Kansas, it's geographically located in the middle of the country and, until recently, had been on an upward trajectory in terms of CHIP enrollments (more on this in a minute).

Speaking of Kansas, it's an interesting state because it represents a quickly-vanishing political model in the U.S. where, although the population tends to vote conservative in national elections, they have been known to vote more liberal on things like state constitutional amendments. Also, despite being an overall red state, the Kansas governor is a Democrat, as are the Lieutenant Governer and one of their members of the House of Representatives.

As I've mentioned before, examining these states' approaches to expanding Medicaid (or not, as with Kansas) should provide insight into the varieties of options on offer as they relate to children, and to what degree they're proving successful. This analysis will be key moving forward as cuts in Medicaid and CHIP begin to take hold in 2027, which I'll elaborate on below.

It's worth taking a slight detour before we get into our charts to explain how we got here. The Budget Reconciliation Act of 2025, also known as the One Big Beautiful Bill Act, has been grabbing headlines since its passage in July of this year. But the truth is that Medicaid and, more pertinent to our discussion, CHIP enrollment had already been enduring challenges.

These complications started back in 2023 under the Biden Administration. Beginning in 2020 and lasting into the spring of 2023, a policy of "continuous enrollment" had been adopted by the federal government where states froze Medicaid disenrollments. In other words, people who may have traditionally rolled off of Medicaid due to changing life circumstances were instead retained. This helped many people maintain a continuity of insurance coverage during difficult times. In part, this involved a suspension on Medicaid eligibility checks, also called "eligibility redeterminations."

These are regular reassessments of whether or not a person still qualifies for Medicaid, CHIP, or any other number of programs. Of note, recent legislation has put this coverage redetermination process in a new light, as we'll talk about in a minute. The continuous enrollment provision resulted in Medicaid and CHIP enrollment increasing to a high of approximately 94 million enrollees by early 2023.

But in the spring of 2023, having judged that the COVID-19 pandemic was largely behind us, the Centers for Medicare & Medicaid Services (CMS), which is the federal agency that administers programs like Medicaid and CHIP, began what is alternately called an "unwinding" or "decoupling" program.

This meant that, as of April 1, 2023, states could, as a recent KFF article stated, "resume disenrolling people after conducting renewals to verify eligibility for the program, though some states delayed the start of their unwinding periods until May, June, or July 2023. Most states took 12 months to complete unwinding renewals and nearly all states completed renewals by August 2024."

The result? Medicaid and CHIP enrollment numbers declined to 78.6 million as of March 2025. And, as we'll see in a minute, people are concerned that those numbers will decline further as a result of the Budget Reconciliation Act, also known as the One Big Beautiful Bill (BBB) Act, which tightens eligibility requirements still further.

Let's take a quick look at the legislation passed in the summer of 2025 that aims to constrain eligibility criteria for programs like Medicaid and CHIP. As mentioned above, this is called the BBB, and I covered it in terms of its potential effects on rural residents in a previous blog post. Now I'd like to zoom out and see how the BBB is affecting Medicaid and CHIP enrollment nationwide.

If we're to evaluate the likely fate of Obamacare generally and CHIP in particular. We need to have a general understanding of this bill's goals. It was signed into law on July 4 of this year and significantly amends who is eligible for health insurance through the federal government. As the authors of a recent Johns Hopkins University School of Public Health article noted, "The law, which the Center on Budget and Policy Priorities estimates will result in up to 15 million more people without health insurance in 2034, includes over $1 trillion in spending cuts to health care through 2034."

Although not directly related to CHIP enrollments, Medicaid work requirements illustrate how cuts will take place across the board starting in 2027. These requirements, which are key to people maintaining their Medicaid coverage, will play an increasingly important role in coverage redeterminations. This means that, at an ever more frequent rate than is now the case, many Medicaid enrollees will have to prove that they are either working at least part time, in school, volunteering, or in some other way contributing to the overall economy or society.

This new provision will take effect on January 1st, 2027, and it is expected to cause many current Medicaid enrollees to lose their coverage based on what some perceive as an increased paperwork burden that falls on the recipient. According to Anthem's website, "if you’re a Medicaid or CHIP member, you may need to complete a renewal every year to make sure you still qualify for your coverage." This coverage redetermination window will narrow under the BBB.

The Center for Heath Care Strategies elaborates on the period necessary for determining Medicaid enrollment eligibility: "States must perform a 'look-back' review to determine whether a Medicaid member met the work requirement in a period of between one and three months before their application. States must also verify that current enrollees continue to meet the requirements for at least one month within each six-month eligibility review period."

As the Johns Hopkins article goes on to say, "Medicaid recipients will have to verify every month that they have met this requirement, which will create a large burden on both the individual recipients and the state systems managing coverage." But even before these enhanced work requirements became law, work requirement provisions and waivers were already pending approval in states like Arizona, Arkansas, Iowa, and Ohio. Right now, Georgia is the only state with a Medicaid work requirement waiver, which began in July 2023 and has been extended to the end of 2026.

As I said, this shortened redetermination period doesn't directly affect CHIP enrollments. But it does demonstrate the kind of stringent requirements that will soon be introduced into the federal insurance landscape. In terms of CHIP, program cuts will mostly affect federal funding to those who are not fully U.S. citizens.

With those basics out of the way, let's pivot to looking at the Medicaid and CHIP Child Enrollment numbers provided by Data.Medicaid.gov for the years 2022-2025. This data comes from September of 2025 and, as I stated earlier, I'll aim to report on November numbers soon. The data set I analyzed covers enrollments through June of 2025. Here is the way CMS defines this metric:

"A point-in-time count of the number of children enrolled in Medicaid and the number of individuals enrolled in CHIP as of the last day of each month. Note that since some states use CHIP to extend coverage to adults, this measure is not strictly limited to children in all states. Includes only those individuals who are eligible for comprehensive benefits."

Data courtesy of Data.Medicaid.gov

Using CMS data, we can track this data over time as I've done in previous blog posts here, here, and here. The most current data for CHIP enrollments is for June of this year. As in past posts, aside from Arizona — which expanded its CHIP enrollment criteria in May of 2024 – we'll start tracking enrollment numbers in January of 2023. These dates represent the starting point at which the federal government started up its Medicaid redetermination process again.

The specifics around the terms of each state's expansion of enrollment criteria can be found in a previous post. I'll post a graph of each state here, starting with Arizona, followed by an overall chart tracking all five states. As you'll see, in every case enrollments have either flattened or begun to decline in recent months. What accounts for this? Although this data set is from June and the BBB didn't pass until July, are states, seeing the writing on the wall, abandoning efforts to increase CHIP enrollment?

It's an interesting question, and one I may explore in a future post. For now, we've entered a period that promises significant challenges, so it will be important to watch how these numbers change as we get closer to 2027. For now, take a look at the following graphs and let me know if you're in any of these states and are seeing patterns starting to form on the ground by contacting us.

Data courtesy of Data.Medicaid.gov

Data courtesy of Data.Medicaid.gov

Data courtesy of Data.Medicaid.gov

Data courtesy of Data.Medicaid.gov

Data courtesy of Data.Medicaid.gov