The Census Bureau recently released data on Medicaid enrollment rates in the United States. For the second year in a row, the number of people on Medicaid has declined.

The decline is due to “Medicaid unwinding,” whereby expanded Medicaid coverage made possible during COVID expired and enrollment qualifications returned to normal.

Two government programs account for the rise between 2020 and 2023. The Families First Coronavirus Response Act was passed and enacted in March 2020. The measure required states to provide continuous coverage for those enrolled in Medicaid as a condition of receiving increased federal funding for the Medicaid program.

Then, in 2021, Congress passed the American Rescue Plan Act of 2021, which extended the continuous coverage mandate for the duration of the pandemic.

The mandates were phased out in 2023, accounting for the decline.

Overwhelmingly, Medicaid goes to children. In 2025, 33.1 percent of children received Medicaid coverage. Among those 65 and over, by contrast, 7.4 percent receive Medicaid.

In Virginia, Medicaid enrollment rose from 1,207,136 people in July 2018 to a peak of 2,188,534 people in May 2023.

Enrollment has declined steadily since. As of this month, there are 1,731,749 people on Medicaid. That number is likely to fall sharply, however, as new requirements come into play for Medicaid expansion adults who are facing new work or volunteer requirements beginning in 2027.

The new requirements apply to those aged 19 through 64; do not have a disability; are not pregnant or eligible for postpartum coverage (12 months after a pregnancy ends); are not a parent, guardian, caretaker relative or family caregiver of a dependent child under age 14 or a person with a disability; and do not qualify for an exception or exclusion.

Gov. Abigail Spanberger and Secretary of Health and Human Resources Marvin Figueroa have said that about 300,000 Virginians could be affected.