After Pandemic-Era Policies and Enhanced Funding End, State Medicaid Officials Report Enrollment Declines and Upward Cost Pressures

KFF October 23, 2024

Costs are limiting states’ coverage of obesity drugs and could affect other Medicaid priorities

States expect national Medicaid enrollment to decline by about 4% and state Medicaid spending to rise by 7% in fiscal year (FY) 2025. These rates follow a larger but anticipated enrollment decline and state spending increase in FY 2024, as pandemic-era policies and federal funding expired, according to KFF’s 24th annual survey of state Medicaid directors.

While state fiscal conditions remain stable heading into FY 2025, the longer-term fiscal and policy outlook for Medicaid programs is less certain. Reduced state revenue collections, the expiration of pandemic-era federal funding, and macroeconomic uncertainties, may discourage states from increasing funding for access to behavioral health, long-term services and supports,...

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