Overview
- Total Medicaid spending rose 8.6% in FY 2025 even as enrollment fell 7.6% following the end of continuous coverage.
- States project about 7.9% spending growth in FY 2026 with enrollment expected to remain largely flat.
- Almost two-thirds of states report at least a 50-50 chance of a Medicaid budget shortfall in FY 2026.
- The reconciliation law imposes $911 billion in future Medicaid cuts and bans new or higher provider taxes, with many provisions taking effect in later years.
- States report slowing reimbursement increases, more rate restrictions, and waning interest in covering GLP-1s for obesity, with 16 programs covering them as of October 1, 2025.