Medicaid / CHIP Enrollment (Monthly)

The Centers for Medicare and Medicaid Services publish monthly enrollment data for Medicaid and the Children's Health Insurance Program. Enrollment ballooned to 94 million in April 2023 under pandemic-era continuous coverage rules, which prevented states from dropping anyone from the rolls regardless of income changes. Once that protection ended, the unwinding began.

Millions of people have come off the rolls since then, but enrollment still sits above the October 2019 baseline of 71.4 million — meaning the pool of people who qualify for public health coverage because they cannot afford private insurance has grown across the cycle, not shrunk.

Research from KFF and Urban Institute has found that a majority of those disenrolled lost coverage for procedural reasons — missed paperwork, renewal notices sent to outdated addresses — rather than because their income rose above eligibility limits. Many of those people are likely still eligible and now uninsured.

Medical costs are the number-one cited cause of bankruptcy filings in the United States. A coverage loss today flows into medical debt tomorrow and Phantom Debt, Falling Behind, and eventually Bankruptcy Filings further out. The disenrolled population is the leading edge of a stress wave the composite will pick up over the next several quarters.