If you're one of the roughly 12 million Americans who qualifies for both Medicare and Medicaid — known as a dual-eligible beneficiary — the latest national enrollment data should be on your radar. As of June 2026, total Medicaid and CHIP enrollment stood at 73.2 million people nationwide, according to CMS data tracked by KFF. That sounds like a large number, but the trend line is moving in the wrong direction: enrollment has dropped by 5.1 million people, or 6%, in just the past 12 months. For seniors who depend on Medicaid to pay their Medicare Part B premiums, cover deductibles, or reduce out-of-pocket drug costs, that decline is not just a statistic — it's a warning sign worth taking seriously.
To understand why this matters so directly to Medicare beneficiaries, it helps to know what Medicaid actually does for people who have both programs. Medicare covers the bulk of your hospital and doctor costs, but it doesn't cover everything. Part B has a standard premium of $185.00 per month in 2026, and there's a $257 Part B deductible before coverage kicks in. Medicare Advantage and Part D plans carry their own cost-sharing. For low-income seniors, Medicaid steps in through what are called Medicare Savings Programs — specifically the Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualifying Individual (QI) programs. These programs can pay your Part B premium, your Part A and Part B deductibles, and your coinsurance. Losing Medicaid eligibility means those protections disappear, often with little warning.
According to CMS.gov data compiled through the Medicaid Performance Indicator Project, there were 66 million people enrolled in full-benefit Medicaid and 7.2 million enrolled in CHIP as of June 2026. It's worth noting that these figures only capture full-benefit enrollees — people receiving limited benefits, such as family planning services only, are excluded from this count. That means the actual number of people with some form of Medicaid connection is even higher than what the tracker shows. For Medicare beneficiaries, the relevant population is the full-benefit group, since Medicare Savings Programs and dual-eligible status require full Medicaid enrollment.
The geographic variation in these enrollment declines is striking and consequential. Total Medicaid and CHIP enrollment has decreased in 49 states and the District of Columbia since June 2025. The range is wide: Iowa saw a less than 1% increase in enrollment, while Indiana experienced a 19% decrease — the steepest drop in the country. States with large senior populations, including Florida, Texas, and Arizona, have all seen enrollment contractions. Child enrollment in Medicaid and CHIP has decreased in 49 states and DC over this period, while adult enrollment has declined in all but five states: Iowa, Missouri, North Carolina, Oklahoma, and South Dakota. For Medicare-age adults, the adult enrollment trend is the one to watch, since most dual-eligible beneficiaries qualify through adult pathways rather than child or family categories.
The policy backdrop driving these numbers is the 2025 reconciliation law, which introduced significant structural changes to Medicaid. Starting in January 2027, adults in the Medicaid expansion group — those who gained coverage under the Affordable Care Act's expansion to individuals earning up to 138% of the federal poverty level — will be required to meet new work and reporting requirements to maintain eligibility. Adults in certain Section 1115 waiver programs will face similar requirements. These are not minor administrative changes. CMS projects that these requirements will reduce Medicaid enrollment over the next 10 years relative to what would have been expected under prior law. For seniors who are near the income thresholds for Medicaid eligibility, this is a structural shift that could affect their coverage even if their personal financial situation hasn't changed.
Work requirements in Medicaid have a complicated history. When similar requirements were implemented in Arkansas in 2018, roughly 18,000 people lost coverage within months — not because they were ineligible, but because they failed to navigate the reporting paperwork correctly. Seniors with limited digital access, language barriers, or cognitive challenges are particularly vulnerable to administrative disenrollment. If you or a family member receives both Medicare and Medicaid, the most important thing you can do right now is confirm that your state Medicaid agency has your current mailing address and contact information on file. Notices about work requirement compliance will be sent by mail, and missing a single letter can trigger a coverage termination.
For Medicare beneficiaries who do lose Medicaid coverage, the Medicare system provides a safety net in the form of Special Enrollment Periods. Losing Medicaid qualifies as a Special Enrollment Period trigger, giving you 60 days from the date of coverage loss to switch Medicare Advantage plans, drop a Medicare Advantage plan and return to Original Medicare, or change your Part D prescription drug plan. This is not the same as the Annual Enrollment Period, which runs October 15 through December 7 each year. An SEP triggered by Medicaid loss can happen at any point in the calendar year, so it's important to act quickly rather than waiting for the next open enrollment window.
Dual Special Needs Plans, or D-SNPs, are a category of Medicare Advantage plan specifically designed for people who qualify for both Medicare and Medicaid. In 2026, D-SNPs are available in most states and typically offer benefits that standard Medicare Advantage plans do not, including care coordination between Medicare and Medicaid services, transportation to medical appointments, meal delivery after a hospital stay, and in some cases, over-the-counter allowances for health-related products. According to CMS.gov data, the number of D-SNP options has grown substantially in recent years, with CMS reporting over 900 D-SNP contracts available nationally in 2026. If you currently have both Medicare and Medicaid and are not enrolled in a D-SNP, it may be worth comparing your current plan against D-SNP options during the Annual Enrollment Period, which closes December 7.
One nuance that often catches beneficiaries off guard is the difference between full dual-eligible status and partial dual-eligible status. Full dual eligibles — sometimes called full-benefit dual eligibles — receive comprehensive Medicaid benefits in addition to Medicare. Partial dual eligibles receive help with Medicare premiums and cost-sharing through the Medicare Savings Programs but may not receive the full range of Medicaid services. The enrollment tracker data discussed here focuses on full-benefit enrollees, but Medicare Savings Program participants are also at risk if Medicaid eligibility rules tighten. If you're currently receiving help with your Part B premium through a Medicare Savings Program, contact your state Medicaid office to confirm your enrollment status and ask specifically whether the 2025 reconciliation law changes affect your eligibility category.
Data Snapshot: According to CMS.gov data published through the Medicaid Performance Indicator Project and analyzed by KFF as of June 2026, national Medicaid and CHIP enrollment stands at 73.2 million — down from a pandemic-era peak that exceeded 94 million in early 2023. The unwinding of continuous enrollment protections that began in April 2023 has already removed more than 20 million people from Medicaid rolls nationally. The current 6% year-over-year decline from June 2025 to June 2026 represents a continuation of that trend, now accelerated by policy changes rather than just eligibility redeterminations. CMS also reports that CHIP enrollment has actually increased in twenty states over the same period, suggesting that some families are transitioning children from Medicaid to CHIP as income levels shift — a dynamic that does not apply to Medicare-age beneficiaries but reflects the broader volatility in public insurance enrollment.
If you're trying to figure out whether you still qualify for Medicaid or a Medicare Savings Program, the income thresholds are worth knowing. In 2026, the QMB program — which pays your Part B premium and most Medicare cost-sharing — is available to individuals with monthly incomes at or below approximately $1,255 and resources below $9,090 (not counting your home, one car, or burial funds). The SLMB program, which pays only the Part B premium, extends to individuals earning up to roughly $1,478 per month. These figures are adjusted annually and vary slightly by state, so checking with your State Health Insurance Assistance Program, known as SHIP, is the most reliable way to confirm current thresholds. SHIP counselors provide free, unbiased help and can be reached through the SHIP National Technical Assistance Center at shiphelp.org.
For beneficiaries in states with the steepest enrollment declines — Indiana at 19%, along with other states that have aggressively implemented redeterminations — the urgency is higher. If you received a Medicaid renewal notice and didn't respond, your coverage may have already been terminated even if you're still eligible. Many states allow reinstatement within 90 days of termination without requiring a full new application. Contact your state Medicaid agency directly, or ask a SHIP counselor to help you navigate the reinstatement process. Acting within that 90-day window can mean the difference between seamless reinstatement and starting the application process from scratch.
Looking ahead to January 2027, when Medicaid work requirements take effect for expansion adults, Medicare beneficiaries in the expansion age group — those between 60 and 64 who gained Medicaid through expansion before becoming Medicare-eligible, or those under 65 with Medicare due to disability — should pay particular attention. The work requirement is set at 80 hours per month of qualifying activity, which can include employment, job training, volunteering, or caregiving. Exemptions exist for people with disabilities, but the exemption process requires documentation and proactive filing. If you or a family member is in this category, beginning to gather documentation of disability or caregiving status now — before the January 2027 deadline — is a practical step that could prevent a coverage gap.