What the Census Data Shows About Medicaid From 2020 to 2025
Medicaid coverage in the United States went through one of its most turbulent periods in program history between 2020 and 2025, according to new data from the U.S. Census Bureau. The findings reflect a dramatic expansion during the pandemic years — driven by continuous enrollment protections that prevented states from removing people from the rolls — followed by a steep drop-off once those protections ended in 2023. If you're trying to understand whether Medicaid may be available to you or a family member right now, this data provides important context for where the program stands and what to expect when you apply.
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Data Snapshot: Medicaid Enrollment Trends by the Numbers
At its peak in early 2023, Medicaid and the Children's Health Insurance Program (CHIP) covered approximately 94.5 million people — a record high, according to CMS data published at Medicaid.gov. That figure represented a roughly 30% increase from pre-pandemic enrollment levels.
Once the Consolidated Appropriations Act of 2023 ended continuous enrollment protections, states began redetermining eligibility for all enrollees. By mid-2024, an estimated 25 million or more redetermination actions had been processed nationally, with millions losing coverage — many due to procedural reasons like outdated addresses rather than actual ineligibility, according to KFF tracking data.
The Census Bureau's Current Population Survey data covering this period shows that uninsured rates, which had fallen to historic lows during the pandemic, began ticking back up in 2023 and 2024 — particularly among adults aged 19–64 in non-expansion states and among Hispanic and Black households.
For context on current income thresholds: the 2024 Federal Poverty Level for a family of four is used as the benchmark — Medicaid eligibility for adults in ACA expansion states is generally set at 138% FPL, while children may qualify at 200% FPL or higher through CHIP, depending on the state. (FPL figures are updated annually by HHS; always check current thresholds at HHS.gov.)
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Why Medicaid Coverage Changed So Dramatically
The Pandemic Expansion (2020–2023)
When COVID-19 hit in March 2020, Congress passed the Families First Coronavirus Response Act, which included a provision requiring states to keep people enrolled in Medicaid continuously — even if their income or circumstances changed — in exchange for enhanced federal matching funds. This meant that people who would normally have been removed during routine eligibility checks stayed covered.
The result was the largest sustained expansion of Medicaid enrollment in the program's history. Families who had previously fallen through coverage gaps, adults who lost jobs, and people who had never applied before all entered the program during this window.
The Unwinding (2023–2024)
Starting April 1, 2023, states were permitted — and required — to begin redetermining eligibility for their entire Medicaid caseloads. This process, known as the "unwinding," was the largest Medicaid administrative undertaking since the ACA expansion in 2014.
The Census Bureau's data captures the downstream effects: coverage rates that had risen steadily from 2020 onward began declining in 2023, with the steepest drops in states that processed redeterminations most aggressively. Children and working-age adults were disproportionately affected.
Many people lost coverage not because they were ineligible, but because: - Their contact information on file was outdated - They didn't respond to renewal notices in time - They were enrolled in a plan that auto-renewed incorrectly - They didn't know they needed to take action
If this happened to you, you may still be able to re-enroll.
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Who Medicaid May Cover Today
Medicaid is a joint federal-state program administered by the Centers for Medicare & Medicaid Services (CMS) and run individually by each state. Because of this structure, eligibility rules, covered services, and application processes differ significantly depending on where you live.
General Eligibility Categories
Medicaid generally covers people in these categories, subject to income and state-specific rules:
- Low-income adults (in the 41 states plus D.C. that have adopted ACA Medicaid expansion, generally up to 138% FPL)
- Children (generally up to 200% FPL or higher through CHIP; some states go up to 300% FPL)
- Pregnant individuals (income limits are often more generous, sometimes up to 200% FPL or above)
- People with disabilities receiving SSI
- Adults 65 and older who meet income and asset requirements
- Parents and caretaker relatives of dependent children (income limits vary widely by state)
In states that have not expanded Medicaid under the ACA, adult eligibility is often much more restrictive — in some cases limited to parents with very low incomes or people with qualifying disabilities.
States That Have Not Expanded Medicaid
As of 2025, a small number of states have still not adopted ACA Medicaid expansion. If you live in one of these states and you're a low-income adult without dependent children or a qualifying disability, you may fall into what's known as the "coverage gap" — earning too much for traditional Medicaid but not enough to qualify for marketplace subsidies. If this applies to you, it's worth checking your state's Medicaid agency directly, as policies can change.
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How to Apply for Medicaid: A Step-by-Step Overview
Step 1: Gather Your Documents
Before you apply, collect the following: - Proof of identity (driver's license, state ID, passport, or birth certificate) - Proof of residency (utility bill, lease agreement, or mail with your current address) - Social Security numbers for all household members applying - Proof of income (recent pay stubs, employer letter, tax return, or self-employment records) - Immigration documents, if applicable - Information about any current health insurance coverage
Step 2: Find Your State's Medicaid Agency
Each state runs its own Medicaid program under a different name. For example: - California calls it Medi-Cal - Texas calls it Texas Medicaid (administered by HHSC) - New York calls it NY Medicaid
You can find your state's Medicaid agency and application portal through Benefits.gov or directly through your state health department's website.
Step 3: Apply
You can apply for Medicaid through several channels: - Online through your state's Medicaid portal or HealthCare.gov (which screens for Medicaid eligibility) - By phone through your state Medicaid agency - In person at your local Department of Social Services or county health office - By mail using a paper application from your state agency
Unlike marketplace insurance, Medicaid has no open enrollment period in most states — you can apply any time of year, and coverage can often begin the same month you apply or even retroactively in some states.
Step 4: Respond Promptly to Any Requests
After submitting your application, your state may request additional documentation. Respond as quickly as possible — delays in providing documents can slow your application or result in a denial.
Step 5: Understand Your Timeline
Most states are required to process standard Medicaid applications within 45 days (or 90 days for disability-based applications). Some states process applications faster. You should receive written notice of a decision.
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If You Lost Medicaid During the Unwinding
If your coverage was terminated during the 2023–2024 redetermination process, you have options:
- Reapply directly — You can submit a new Medicaid application at any time. If your income and household situation still meet your state's eligibility criteria, you may be able to re-enroll.
- Request a fair hearing — If you believe your coverage was terminated in error, you have the right to appeal. Your termination notice should include instructions on how to request a hearing.
- Check marketplace options — Losing Medicaid coverage qualifies as a Special Enrollment Period for marketplace plans. You may be eligible for subsidized coverage through HealthCare.gov.
- Contact a navigator or enrollment assister — Free, trained enrollment assisters are available in every state to help you understand your options at no cost.
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People Also Ask
Q: What income level makes you eligible for Medicaid? In states that expanded Medicaid under the ACA, adults generally may qualify if their income is at or below 138% of the Federal Poverty Level. Children may qualify at higher thresholds through CHIP — often 200% FPL or above. Income limits vary significantly by state, household size, and eligibility category. Check your state's Medicaid agency for current figures.
Q: Can I apply for Medicaid if I'm working? Yes. Having a job does not automatically disqualify you from Medicaid. Eligibility is based on your household's total income relative to the Federal Poverty Level, not employment status. Many working adults and families with modest incomes may find that Medicaid is available to them, particularly in ACA expansion states.
Q: How long does it take to get approved for Medicaid? Most states are required to process standard Medicaid applications within 45 days of receiving a complete application. Disability-based applications may take up to 90 days. Some states process applications more quickly. You'll receive a written notice of the decision, and coverage may begin the month you applied in many states.
Q: What happens if my Medicaid application is denied? If your application is denied, you have the right to appeal the decision through a fair hearing process. Your denial notice will include the reason for denial and instructions for requesting a hearing. You may also want to contact a free enrollment assister or legal aid organization in your area for guidance.
Q: Does Medicaid cover dental and vision? Medicaid coverage for dental and vision services varies by state. Federal law requires states to cover these services for children through CHIP and Medicaid. For adults, dental and vision coverage is optional under federal rules — some states offer it, others do not, and coverage levels differ. Check your state's Medicaid benefit package for specifics.
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Last reviewed: October 2026