March 2025 Update: Missouri Medicaid enrollment stable since unwinding ended
Stability in enrollment masks shifts among categorical groups
April 15, 2025 (updates based on March 2025 state administrative data).
Total net enrollment of Missouri’s Medicaid program has remained relatively stable in the last ten months at between 1.25 million to 1.27 million. In March 2025, 1.25 million were enrolled. However, the relative stability of the aggregate enrollment masks shfts in enrollment categories: while enrollment of children, disabled and custodial parents has fallen in that period, enrollment in Adult Expansion Group (AEG) and pregnant women categories has risen. These findings are based on analysis by CAHSPER at Washington University in St. Louis of state of Missouri Family Support Division data, posted on their website.
Factors affecting enrollment. The recent changes in enrollment may reflect changes in the process of reverifying enrollment (a regular process done annually), as well as normal growth in Medicaid over time due to population growth. During the Public Health Emergency (PHE) annual reverifications of Medicaid enrollment were paused by the federal government, which meant that those enrolled in Medicaid during that period were not disenrolled. Federal law passed at the end of 2022 called for an end to the PHE, and a renewal of the recertification process, commonly called the “unwinding” of the pandemic as it is affecting Medicaid. The process of recertifying enrollment in Medicaid began again in June 2024.
Enrollment growth in recent months led by increases in pregnant women and AEG. Since the end of the unwinding of the PHE, net enrollment in Missouri’s Medicaid program decreased by over 55,000 (see Figure). However, enrollment in the AEG grew by over 17,000 and pregnant women by over 3,600. It is noteworthy that the sate recently enacted an expansion of post-partum coverage for pregnant women (changes approved by CMS in November 2023). Enrollment in the pregnant women category declined until May 2024 (the end of the unwinding), but has increased significantly since May 2024.
In contrast, enrollment of children in MOHealthNET (the largest eligibility group) has dropped significantly, by over 45,500, since June 2024, and the enrollment of the disabled and custodial parents has also dropped by about 15,000 each. It is worth noting that in proportional terms the biggest drops in enrollment since June 2024 has been in the categories of: custodial parents (-18.6%) and disability (-11.6%), larger than the drop in children (-7.5%); the number of children enrolled is the largest of any grpup on MOHealthNET. In contrast pregant women has grown 11.5%, and AEG 5.2% (figures not shown here).
Enrollment in the disability category has been slowly dropping since before the Medicaid expansion began; the only category to show a drop in enrollment over the January 2020 to March 2025 period (see graph).
Update on Medicaid expansion. As shown in the graph below, the current enrollment in the Adult Expansion Group (AEG) is nearly 350,000 in March 2025. AEG enrollment fell in the first seven months of the unwinding, but has grown over 17,000 since then, perhaps suggesting there is some churning from other categories into the AEG from other populations.
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Report prepared by analysts at Center for Advancing Health Services Policy and Economics Research (CAHSPER), Institute for Public Health (IPH), Washington University in St. Louis.