Updated November 2026, using the latest federal data (enrollment as of July 1, 2024). Most people on Medicaid do not get their benefits directly from the state. They are enrolled in a managed care plan, a private or nonprofit health plan the state pays a fixed monthly amount per member to arrange their care. Nationally, 84.8% of 86,916,019 Medicaid enrollees were in some form of managed care in 2024, and 78.2% (67,932,939 people) were in comprehensive managed care plans that cover most medical services.
The table below shows each state’s Medicaid enrollment and the share of enrollees in managed care, from the Centers for Medicare & Medicaid Services (CMS) Medicaid managed care enrollment report. The insurers that hold these contracts, such as Centene, Elevance Health, UnitedHealthcare Community Plan, Molina, CareSource and AmeriHealth Caritas, are listed in the Medicaid section of our List of Health Insurance Companies.
Key Findings
- Managed care is the norm. 17 states and territories enrolled at least 90% of Medicaid members in comprehensive managed care.
- A few states still run most of Medicaid directly. Comprehensive managed care covered less than a quarter of enrollees in North Dakota, Idaho, Arkansas, Colorado and Alabama. Maine, Montana, South Dakota and Wyoming reported no comprehensive managed care program, and Alaska and Connecticut reported no managed care enrollment of any kind.
- Enrollment is falling. Medicaid and CHIP enrollment was 72.9 million in July 2026, and Medicaid alone was down 4.6 million (7%) from July 2025, as states continued eligibility renewals (CMS enrollment snapshot).
What “Any” and “Comprehensive” Managed Care Mean
Comprehensive managed care organizations (MCOs) cover most acute care, such as doctor visits, hospital stays and prescriptions, for a fixed monthly payment. “Any managed care” also counts narrower arrangements, such as dental plans, behavioral health plans, transportation brokers and primary care case management, in which a doctor is paid a small fee to coordinate care. An enrollee in a dental plan only is counted under “any” but not under “comprehensive.”
Medicaid Managed Care Enrollment by State, 2024
Sorted by the share of enrollees in comprehensive managed care. The last column shows the comprehensive share in 2016 for comparison.
| State | Medicaid Enrollees | In Any Managed Care | In Comprehensive Managed Care | Comprehensive Share, 2016 |
|---|---|---|---|---|
| Hawaii | 432,222 | 100.0% | 100.0% | 98.9% |
| Vermont | 165,372 | 100.0% | 100.0% | 62.1% |
| Puerto Rico | 1,400,933 | 100.0% | 100.0% | 100.0% |
| Nebraska | 351,141 | 99.8% | 99.8% | 78.4% |
| Michigan | 2,416,518 | 97.8% | 98.0% | 49.9% |
| Oregon | 1,340,084 | 89.5% | 98.0% | 80.6% |
| California | 14,904,950 | 93.8% | 96.1% | 76.9% |
| Maryland | 1,762,462 | 94.5% | 94.5% | 81.5% |
| Tennessee | 1,526,625 | 94.1% | 94.1% | 92.4% |
| Iowa | 649,899 | 93.9% | 93.0% | 90.0% |
| Virginia | 1,953,730 | 86.0% | 92.8% | 68.4% |
| Texas | 4,141,972 | 93.3% | 92.8% | 88.4% |
| Pennsylvania | 2,967,715 | 95.1% | 92.6% | 81.1% |
| New Jersey | 1,700,910 | 91.4% | 91.5% | 92.7% |
| New Hampshire | 199,513 | 91.1% | 91.1% | 66.2% |
| Ohio | 3,018,792 | 88.2% | 90.1% | 79.9% |
| Kentucky | 1,449,651 | 90.0% | 90.0% | 92.7% |
| District of Columbia | 275,158 | 96.0% | 86.6% | 71.9% |
| Delaware | 259,168 | 91.1% | 84.7% | 88.6% |
| Rhode Island | 317,797 | 98.9% | 84.2% | 85.7% |
| Washington | 1,984,868 | 83.7% | 84.1% | 85.6% |
| Louisiana | 1,676,215 | 91.5% | 83.7% | 84.0% |
| Missouri | 1,222,962 | 83.6% | 83.6% | 50.3% |
| Minnesota | 1,204,793 | 83.2% | 83.3% | 74.9% |
| New Mexico | 900,757 | 81.7% | 81.7% | 77.4% |
| Indiana | 1,972,638 | 81.6% | 81.6% | 75.9% |
| Kansas | 453,240 | 79.3% | 79.3% | 89.7% |
| North Carolina | 3,057,965 | 84.4% | 79.1% | 0.1% |
| Arizona | 2,181,548 | 84.5% | 78.7% | 84.4% |
| Utah | 331,012 | 97.4% | 78.6% | 83.1% |
| West Virginia | 533,405 | 87.0% | 76.4% | 70.5% |
| Illinois | 3,418,634 | 75.6% | 75.6% | 60.9% |
| Nevada | 824,507 | 74.1% | 74.4% | 63.8% |
| Mississippi | 645,050 | 74.2% | 74.2% | 68.7% |
| Florida | 4,363,948 | 89.3% | 70.0% | 81.7% |
| Georgia | 2,314,875 | 85.3% | 68.9% | 65.6% |
| New York | 6,964,926 | 72.6% | 68.4% | 73.5% |
| Wisconsin | 1,339,124 | 71.1% | 67.0% | 62.6% |
| South Carolina | 1,354,616 | 60.1% | 60.0% | 60.1% |
| Oklahoma | 1,040,358 | 72.3% | 54.6% | 0.0% |
| Massachusetts | 1,983,201 | 61.8% | 45.8% | 46.3% |
| North Dakota | 105,070 | 23.4% | 23.4% | 22.9% |
| Idaho | 331,580 | 92.9% | 6.4% | 0.8% |
| Arkansas | 900,323 | 89.2% | 5.4% | 0.0% |
| Colorado | 1,197,490 | 90.2% | 0.4% | 10.0% |
| Alabama | 1,098,614 | 76.3% | 0.0% | 0.0% |
| Alaska | 236,414 | None | 0.0% | |
| American Samoa | 33,746 | None | ||
| Connecticut | 1,085,951 | None | 0.0% | |
| Guam | 34,824 | None | ||
| Maine | 415,298 | 88.2% | None | 0.0% |
| Montana | 213,159 | 82.1% | None | 0.0% |
| Northern Mariana Islands | 20,200 | None | ||
| South Dakota | 144,864 | 73.8% | None | 0.0% |
| Virgin Islands | 22,179 | None | ||
| Wyoming | 73,053 | 0.3% | None | 0.2% |
| United States | 86,916,019 | 84.8% | 78.2% | 68.0% |
Some states report enrollment on a different basis, such as a point-in-time count other than July 1 or cumulative enrollment for the year; CMS notes these exceptions in the source file. Because states count programs differently, a state’s comprehensive share can exceed its “any” share. Tennessee could not provide an unduplicated comprehensive count, so CMS used its total managed care figure. Blank cells mean the state did not report a figure. Totals include the territories that reported.
Why Medicaid Managed Care Matters to Enrollees
In a managed care state, the plan, not the state, decides which doctors and hospitals are in network, which drugs are covered and when prior authorization is required. Plans compete for state contracts every few years, and when a state rebids its program, members can be moved to a new plan. If you receive a notice that your plan is changing, you usually have a window, often 90 days, to choose a different plan.
For news on state contracts and enrollment, see our Medicaid and CHIP hub. For prior authorization rules that apply to Medicaid plans, see our Prior Authorization Report Card.
Source
CMS, Medicaid Managed Care Enrollment and Program Characteristics, share of Medicaid enrollees in managed care by state (2016 to 2024), data.medicaid.gov; CMS Medicaid and CHIP Eligibility Operations and Enrollment Snapshot, July 2026.