Medicaid recipient demographics have shifted sharply since the pandemic. As of December 2025, roughly 75.7 million people are enrolled in Medicaid and the Children’s Health Insurance Program across the 50 states and the District of Columbia, down from a peak near 94 million before states resumed eligibility redeterminations in 2023.1Medicaid.gov. December 2025 Medicaid and CHIP Enrollment Data Highlights Children make up the largest single group. Women outnumber men. Most non-disabled adult enrollees work. And a small slice of enrollees — the elderly and people with disabilities — accounts for roughly half of what the program spends.
How the Enrollment Picture Changed After the Unwinding
Between 2023 and 2025, more than 25 million people lost Medicaid coverage over an 18-month unwinding period after the end of the continuous enrollment protection that had been in place since early 2020. Many were dropped for procedural reasons, such as not returning paperwork, rather than for actually exceeding income limits. Because children were more likely to remain eligible through that process, they now represent a bigger share of the rolls than they did at the pandemic peak, when expansion adults were being added in large numbers.
Age Breakdown of Enrollees
Children are now the largest group on Medicaid. About 36 million children were enrolled in December 2025, or 47.6% of total program enrollment.1Medicaid.gov. December 2025 Medicaid and CHIP Enrollment Data Highlights Working-age adults hold most of the remainder, with elderly adults 65 and older and people who qualify through a disability making up a smaller but heavy-cost segment.
The older FY 2022 numbers from the Medicaid and CHIP Payment and Access Commission, when total enrollment was higher, showed children at roughly 36%, working-age adults (including the ACA expansion population) at about 44%, individuals eligible through disability at about 10%, and adults 65 and older at about 10%.2Medicaid and CHIP Payment and Access Commission. MACStats Medicaid and CHIP Data Book 2024 The higher child share today is a direct effect of adults being dropped disproportionately during the unwinding.
Are Medicaid Recipients Working?
Most non-elderly, non-disabled adults on Medicaid who are not also on Medicare have a job. About 64% work either full-time or part-time. Add in people who aren’t working because of caregiving, school, or a health condition, and 92% have a clear reason they aren’t in the full-time workforce. The pattern reflects the kind of jobs many enrollees hold: service industry and retail work that either doesn’t offer affordable coverage or pays low enough wages to qualify for Medicaid.
Income Levels
Eligibility is tied to the Federal Poverty Level. For 2026, the FPL is $15,960 for a single person and $33,000 for a family of four in the 48 contiguous states.3U.S. Department of Health and Human Services. 2026 Poverty Guidelines States that adopted the ACA Medicaid expansion cover most adults up to 138% of the FPL, or about $22,025 for an individual and $45,540 for a family of four.4HealthCare.gov. Medicaid Expansion and What It Means for You
About one-third of enrollees under 65 have household incomes below 100% of the FPL, and a roughly equal share falls between 100% and 199%. That second band includes much of the ACA expansion population. Income for most categories — children, pregnant women, and expansion adults — is calculated using Modified Adjusted Gross Income.5Medicaid.gov. Eligibility Policy Elderly and disabled applicants often face different rules, including asset limits that vary by state.
Race and Ethnicity
The racial and ethnic composition of Medicaid enrollees does not match the country as a whole. Non-Hispanic White individuals are the largest single group at roughly 36% to 40%, depending on the data source and year. Hispanic individuals make up about 31%, and Black non-Hispanic individuals about 18% to 19%.6Medicaid.gov. Race and Ethnicity of the National Medicaid and CHIP Population in 2020 Asian, Native American, and other groups account for the rest.
Black and Hispanic Americans are enrolled at rates above their share of the general population, and Medicaid is the primary source of coverage for a large portion of both groups, especially in states that expanded eligibility. In non-expansion states, many people of color fall into the coverage gap: too much income for the state’s Medicaid rules but too little for marketplace subsidies.
Gender
Women are about 55% of Medicaid enrollees nationally. Several forces push that number up: pregnancy-related coverage, a separate eligibility pathway for pregnant women, higher rates of single-parent households headed by women in low income brackets, and longer life expectancy that increases women’s share of the aged enrollment category. State-level splits run from roughly even in Alaska to nearly 60% female in Mississippi and Texas.
Where the Spending Actually Goes
Who is enrolled and who costs the program money are two different questions. Children are about 35% of full-benefit enrollment but only 15% of total spending, with per-enrollee costs averaging around $3,321. Elderly adults and people eligible through disability are about 19% of enrollment but roughly 51% of all Medicaid expenditures.7Medicaid and CHIP Payment and Access Commission. Medicaid Spending by State, Eligibility Group, and Dually Eligible Status Per-enrollee spending averages about $20,950 for people with disabilities and $20,194 for adults 65 and older, roughly six times the per-child figure.
This split is why Medicaid functions as two programs at once: a mainstream health program for children and low-income families, and the country’s largest funder of long-term care for older adults and people with disabilities.
State Differences
Geographic variation is largely a story of state policy. As of 2025, 41 states including the District of Columbia have adopted Medicaid expansion; 10 have not.1Medicaid.gov. December 2025 Medicaid and CHIP Enrollment Data Highlights Expansion states have a much larger share of non-disabled working-age adults on their rolls. Non-expansion states lean more heavily toward children and the traditional categories of aged, blind, and disabled.
The share of a state’s residents on Medicaid varies more than most people expect. In FY 2024, it ran from about 10% in Utah to more than 43% in Louisiana. Poverty rates, employer coverage, cost of living, and state choices about optional eligibility groups all feed into that spread.
Citizenship and Immigration Status
Federal law generally requires U.S. citizenship or a qualifying immigration status for Medicaid. Lawful permanent residents and other qualified non-citizens face a five-year waiting period after getting their status before they can enroll.8HealthCare.gov. Coverage for Lawfully Present Immigrants Refugees, asylees, and trafficking victims are exempt from the wait. States can also choose to cover lawfully residing pregnant women and children without the five-year delay, an option created by the Children’s Health Insurance Program Reauthorization Act of 2009.9Medicaid.gov. Medicaid and CHIP Coverage of Lawfully Residing Children and Pregnant Women Undocumented immigrants are generally not eligible for full Medicaid, though federal law requires coverage of emergency medical services regardless of status.
People Enrolled in Both Medicare and Medicaid
About 12 million people are dually eligible for Medicare and Medicaid based on the most recent comprehensive federal data. They are among the most medically complex and expensive enrollees in either program. Medicare handles their acute care, hospital stays, and physician visits; Medicaid picks up nursing facility care, personal care services, and Medicare premiums and cost-sharing.
Full dual eligibility means access to the complete Medicaid benefit package alongside Medicare. Partial dual eligibility means Medicaid helps only with Medicare premiums and copayments, without full Medicaid benefits. Because this group drives so much spending in both programs, it draws steady policy attention around care coordination and cost.