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MACPAC Releases 2019 Edition of MACStats: Medicaid and CHIP Data Book

New data show a cumulative decrease in Medicaid and CHIP enrollment of 2.6 percent over the past two years


The Medicaid and CHIP Payment and Access Commission (MACPAC) today released the 2019 edition of the MACStats: Medicaid and CHIP Data Book, with updated data on national and state Medicaid and State Children’s Health Insurance Program (CHIP) enrollment, spending, benefits, and beneficiaries’ health, service use, and access to care. A notable trend in this year’s data book is the decrease in national enrollment in Medicaid and CHIP for the second year in a row: 1.4 percent from July 2018 to July 2019 and 1.2 percent over the same period in the previous year.

Although enrollment increased in some states, it declined in 34 states and the District of Columbia. These included states that did not expand Medicaid, such as Missouri (where enrollment decreased by 10.9 percent), and those that did expand, such as California (which experienced a 2.6 percent decline). States where enrollment grew ranged from 0.2 percent in New Mexico and New York, to 27.8 percent in Virginia after that state expanded Medicaid to low-income adults in January 2019.

MACStats is published annually in December and updated regularly on, and brings together the range of Medicaid and CHIP statistics—including eligibility and enrollment, benefits, service use, and access to care, and state and federal spending—that are often difficult to find across multiple sources. “This publication is a trusted resource for policymakers, journalists, stakeholders, patient advocates—anyone who wants to fully understand what’s happening with the health care of the more than one-quarter of the U.S. population who are covered by Medicaid or CHIP,” said MACPAC Chair Melanie Bella.

More highlights from this year’s edition of MACStats include:

  • Over 40 percent of all individuals enrolled in Medicaid or CHIP in 2018 had family incomes below 100 percent of the federal poverty level (FPL). Almost 6 out of 10 (59.7 percent) beneficiaries had incomes of less than 138 percent FPL, the threshold used to determine eligibility for Medicaid in states that have expanded Medicaid to low-income adults (Exhibit 2).
  • Medicaid and CHIP accounted for 17.2 percent of national health expenditures in calendar year 2017, less than either Medicare at 20.2 percent or private insurance at 33.9 percent (Exhibit 3).
  • Medicaid’s share of state budgets in 2017 was 28.9 percent when federal and state funds were counted, but accounted for only 19.7 percent of state budgets when only state general revenue was included, and 16.0 percent when the share included state and local funds, such as general revenue, provider taxes, and proceeds from bonds (Exhibit 13).
  • Disproportionate share hospital (DSH), upper payment limit, and other types of supplemental payments accounted for over half of fee-for-service payments to hospitals in FY 2018 (Exhibit 24).
  • Both children and adults whose primary coverage source was Medicaid or CHIP reported seeing the doctor slightly less than those with private coverage, but more than individuals who were uninsured (Exhibits 40 and 44).

The 2019 edition includes reprints of 11 exhibits from the 2018 data book that present statistics on enrollment and spending by eligibility group. These exhibits have not been updated from last year’s publication as newer data from the Transformed Medicaid Statistical Information System (T-MSIS) have only recently become available.  MACPAC is in the process of validating the T-MSIS data and will provide updated tables on its website when validation is complete.

Visit this link for the PDF and spreadsheet versions of the December 2019 MACStats: Medicaid and CHIP Data Book. Visit for MACPAC’s newest issue briefs on Changes in Medicaid and CHIP Enrollment and Implementation of the Home- and Community-Based Services Settings Rule. Follow us on Twitter @macpacgov.



The Medicaid and CHIP Payment and Access Commission is a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on a wide array of issues affecting Medicaid and CHIP. For more information, please visit