Medicaid and CHIP Enrollment by State 2026: Full Ranking
March 2026 Medicaid and CHIP State Enrollment Snapshot
This ranking compares comprehensive Medicaid and CHIP enrollment on the final day of March 2026. The unit is enrolled people, and larger totals rank higher. It covers all 50 states and the District of Columbia.
CMS reported 67,080,865 Medicaid enrollees and 7,213,496 people with CHIP-funded coverage, for a combined total of 74,294,361. CHIP includes Medicaid-expansion CHIP, separate CHIP programs and pregnant adult women covered through separate CHIP. The CMS March 2026 Snapshot describes the monthly state submissions as preliminary.
The table measures coverage scale. It does not measure enrollment rate, spending, quality, future loss of coverage or the number of people subject to 2027 eligibility rules.
California ranks first.
Wyoming ranks 51st.
Medicaid plus CHIP-funded coverage.
Medicaid fell by 4.2 million and CHIP by 120,000. California changed its reporting in March 2026, so the national comparison includes a break in that state’s series.
State-submitted CMS values for every state and D.C.; no projected rows are used in the ranking.
Released June 26, 2026; checked July 15, 2026.
What the Enrollment Metric Measures
The measure counts people with comprehensive Medicaid or CHIP benefits on March 31, 2026. Comprehensive coverage generally means a broad package of medically necessary services rather than a limited benefit such as family-planning-only coverage or assistance limited to Medicare premiums and cost sharing.
Absolute enrollment answers a scale question: where are the largest covered populations? A separate population denominator would be required to compare enrollment rates.
Not included: Basic Health Program enrollment, annual unduplicated participation, partial-benefit-only coverage, program spending, utilization and service quality.
What Changed Over the Previous Year
From March 2025 to March 2026, CMS reported a 4.2 million decline in Medicaid enrollment, equal to 6%, and a 120,000 decline in CHIP enrollment, equal to 2%. Because the published changes are rounded, the combined movement is best described as about 4.3 million rather than as an exact total.
The same CMS enrollment snapshot reports that Medicaid child enrollment combined with CHIP fell by 1.8 million, while Medicaid adult enrollment fell by 2.5 million.
Enrollment Composition: Children, Adults and CHIP
The national total contains 35.6 million children enrolled in Medicaid or CHIP and 38.7 million adults enrolled in Medicaid. Rounded shares are approximately 48% children and 52% adults.
Children
35.6 million children were enrolled in Medicaid or CHIP. This group accounts for nearly half of the combined enrollment total.
Adults
38.7 million adults were enrolled in Medicaid. The category includes adults covered through several eligibility pathways, not only the ACA expansion group.
CHIP-funded coverage
7.21 million people had CHIP-funded coverage, equal to about 9.7% of the combined Medicaid and CHIP total.
Why composition matters
A state’s total rank does not show whether its enrollment is concentrated among children, expansion adults, older adults or people with disabilities.
Top 10 Jurisdictions by Enrollment
The chart provides a compact view of the leaders without duplicating them in a second table. California is the 100% reference.
Exact values for all jurisdictions appear in the searchable ranking below.
Why State Enrollment Totals Differ
California and Texas
Both are large-population states, yet California reports 11.96 million enrollees compared with 3.99 million in Texas. Population scale matters, but eligibility pathways, take-up and program design also affect the result.
Alabama and Minnesota
CHIP-funded coverage accounts for about 21.1% of Alabama’s combined total but about 0.4% of Minnesota’s. States use Medicaid-expansion CHIP and separate CHIP structures differently.
New York, Minnesota, Oregon and D.C.
Basic Health Program or similar coverage is reported outside this table. The ranking therefore does not capture every form of publicly supported low-income coverage in these jurisdictions.
D.C. and Delaware
Their totals differ by only 240 people, but similar absolute enrollment does not imply similar enrollment rates because their population sizes and coverage systems differ.
Who the 2027 Medicaid Rules Apply To
The 2027 provisions concern defined adult populations, not everyone counted in the state ranking.
Six-month eligibility renewals
Beginning with renewals scheduled on or after January 1, 2027, most people in the ACA adult expansion group move from annual to six-month renewals. CMS guidance explains transition options and the exemption for qualifying American Indians and Alaska Natives. See CMS State Medicaid Director Letter 26-001.
Applicable individuals
Community engagement generally applies to adults in the ACA expansion group and certain adults receiving minimum essential coverage through qualifying Section 1115 demonstrations. The typical age range is 19 through 64, subject to statutory exclusions and exceptions.
Major exclusions and exceptions
Examples include pregnancy and postpartum coverage, medical frailty or special medical needs, qualifying caregivers, certain former foster-care beneficiaries, qualifying American Indians and Alaska Natives, totally disabled veterans and some people already meeting TANF or SNAP work rules.
Activities that can qualify
The law recognizes work, community service, qualifying work programs, at least half-time education and certain combinations of activities. The general monthly threshold is 80 hours. See the CMS community engagement bulletin.
CBO outlook: average monthly Medicaid enrollment is projected to decline from 82 million in 2026 to 73 million in 2036, driven mainly by provisions affecting the expansion population. CBO excludes supplemental or partial-only coverage from its health insurance coverage estimates. See CBO’s February 2026 projections.
Methodology and Data Limitations
Metric and unit
People receiving comprehensive Medicaid or CHIP benefits on the last day of March 2026.
Ranking direction
National rank is calculated from the unrounded enrollment value, highest to lowest.
Coverage
All 50 states and the District of Columbia. Territories are excluded from this 51-jurisdiction table.
Source
The row values come from preliminary monthly Performance Indicator Data submitted by states to CMS.
CHIP definition: CHIP enrollment includes people with CHIP-funded coverage through Medicaid-expansion CHIP, separate CHIP programs and pregnancy coverage through separate CHIP.
Comparison limits: CMS warns that definitions differ from T-MSIS and other datasets. The values should not be combined with annual participation counts, enrollment rates, spending measures or CBO average monthly projections.
Rounding: table values remain whole-person counts. Chart labels, shares and summary figures are rounded only after calculation.
Regions: Northeast, Midwest, South and West follow the U.S. Census Bureau region structure. D.C. and Delaware are classified in the South.
Full Ranking of 50 States and the District of Columbia
Search, filter and sort the existing HTML rows. The row limit is applied after search, region and sort, so “First 10 matches” means the first ten results in the current view. The rank badge always shows the original national rank.
Showing 20 of 51 matching jurisdictions.
National rank stays fixed when the view is filtered or sorted.
| Rank and jurisdiction | Enrollment | Region |
|---|---|---|
| #1California | 11,961,393 | West |
| #2New York | 6,418,639 | Northeast |
| #3Texas | 3,988,590 | South |
| #4Florida | 3,569,764 | South |
| #5Pennsylvania | 2,992,549 | Northeast |
| #6Illinois | 2,981,256 | Midwest |
| #7North Carolina | 2,845,546 | South |
| #8Ohio | 2,666,651 | Midwest |
| #9Michigan | 2,197,050 | Midwest |
| #10Georgia | 1,841,857 | South |
| #11Washington | 1,786,614 | West |
| #12New Jersey | 1,742,089 | Northeast |
| #13Virginia | 1,657,743 | South |
| #14Arizona | 1,640,219 | West |
| #15Massachusetts | 1,552,801 | Northeast |
| #16Indiana | 1,419,131 | Midwest |
| #17Tennessee | 1,391,527 | South |
| #18Maryland | 1,390,330 | South |
| #19Louisiana | 1,360,482 | South |
| #20Kentucky | 1,294,021 | South |
| #21Oregon | 1,284,261 | West |
| #22Missouri | 1,248,239 | Midwest |
| #23Colorado | 1,184,224 | West |
| #24Minnesota | 1,136,089 | Midwest |
| #25Wisconsin | 1,118,919 | Midwest |
| #26Oklahoma | 970,323 | South |
| #27South Carolina | 963,899 | South |
| #28Alabama | 935,776 | South |
| #29Connecticut | 901,871 | Northeast |
| #30Arkansas | 794,237 | South |
| #31Nevada | 725,365 | West |
| #32New Mexico | 679,380 | West |
| #33Iowa | 673,650 | Midwest |
| #34Mississippi | 586,266 | South |
| #35West Virginia | 487,896 | South |
| #36Kansas | 396,786 | Midwest |
| #37Hawaii | 387,074 | West |
| #38Nebraska | 335,025 | Midwest |
| #39Maine | 333,291 | Northeast |
| #40Utah | 326,194 | West |
| #41Idaho | 315,085 | West |
| #42Rhode Island | 290,446 | Northeast |
| #43District of Columbia | 238,350 | South |
| #44Delaware | 238,110 | South |
| #45Alaska | 208,774 | West |
| #46Montana | 207,647 | West |
| #47New Hampshire | 173,797 | Northeast |
| #48Vermont | 148,409 | Northeast |
| #49South Dakota | 140,568 | Midwest |
| #50North Dakota | 104,097 | Midwest |
| #51Wyoming | 62,061 | West |
No jurisdictions match the selected search and filters.
All 51 values sum to 74,294,361. Open the CMS state enrollment dataset.
Insights From the Ranking
Concentration at the top
The top 10 jurisdictions contain 55.8% of all enrollment in the table. The top five contain 38.9%.
Median jurisdiction
Oklahoma ranks 26th with 970,323 enrollees. California’s total is about 12.3 times the median.
Regional totals
The South has 24,554,717 enrollees across 17 jurisdictions, followed by the West with 20,768,291.
Close positions
Pennsylvania exceeds Illinois by 11,293 people, while D.C. exceeds Delaware by 240. Small revisions could change close ranks.
How to Read the Results
Use the ranking to compare the size of covered populations. Do not interpret a high rank as evidence of better access, greater generosity or higher fiscal risk.
Comparisons of enrollment rates require state population denominators matched to the same period. Analysis of reform exposure requires category-level enrollment and exemption data rather than total Medicaid and CHIP enrollment.
Frequently Asked Questions
Which jurisdiction has the largest Medicaid and CHIP enrollment?
California ranks first with 11,961,393 people enrolled on March 31, 2026.
Does CHIP mean only separate CHIP programs?
No. The CMS measure includes all CHIP-funded coverage, including Medicaid-expansion CHIP, separate CHIP and pregnancy coverage through separate CHIP.
Why should California’s annual change be treated cautiously?
California revised its reporting in March 2026 to exclude limited-benefit individuals and did not revise earlier months, creating a break in the state’s series.
Does the table show the percentage of residents enrolled?
No. It ranks absolute counts. A state population denominator is required to calculate an enrollment rate.
Does a high rank show how many people face the 2027 community engagement rules?
No. Those rules concern defined adult groups and include exclusions and exceptions. Children and many other enrollees in the table are outside that population.
Why does the table initially show only 20 rows?
The shorter default view reduces mobile page length. Select “All matches” to display the complete 51-jurisdiction ranking.
Sources
CMS March 2026 Enrollment Snapshot
National totals, annual changes, definitions, enrollment composition and data-use limitations.
https://www.medicaid.gov/resources-for-states/downloads/eligib-oper-and-enrol-snap-mar2026.pdf
CMS State Enrollment Dataset
State-level Medicaid and CHIP enrollment values used for all 51 ranking rows.
https://data.medicaid.gov/dataset/6165f45b-ca93-5bb5-9d06-db29c692a360
CMS Six-Month Renewal Guidance
Affected adult expansion population, effective date and renewal transition rules.
https://www.medicaid.gov/federal-policy-guidance/downloads/smd26001.pdf
CMS Community Engagement Bulletin
Applicable individuals, qualifying activities, exclusions and exceptions.
https://www.medicaid.gov/federal-policy-guidance/downloads/cib12082025.pdf
CBO Federal Health Subsidies Baseline
Average monthly Medicaid enrollment projections for 2026–2036 and category-level changes.
https://www.cbo.gov/system/files/2026-05/62380-Federal-Health-Subsidies.pdf
U.S. Census Bureau Regions and Divisions
Regional assignments used in filters and regional totals.
