Missouri Medicaid November 2025 Update: First Report on Open Enrollment
Open enrollment is Nov. 2024-Jan. 2025; growth in Medicaid applications down slightly from 2024; state continues to make progress on pending applications
November 2025 — The open enrollment period for the Affordable Care Act (ACA) marketplaces (sometimes called “Obamacare”) is open November 2024-January 2025, and historically during open enrollment Medicaid applications grow as applicants may realize they may be eligible for Medicaid instead (if they meet the Medicaid requirements).
The state of Missouri has released their first report on Medicaid applications and enrollment for November 2025. The number of applications to Medicaid rose from 23,031 to 29,686 (up 29%) from October to November 2025; however, that level of applications is 13% below the number of applications received in November 2024 (33,934). It is too early to tell what this drop indicates; but it is worth watching the whole open enrollment period.
Results summarized here will show that enrollment on Medicaid dropped slightly in November 2025, but has been roughly steady at about 1.3 million since the end of the “unwinding” period that ended after the Public Health Emergency (PHE) ended in May 2024. The changes in enrollment do not capture important changes in categories of enrollment since the unwinding ended as enrollment dropped significantly for custodial adults, people with disabilities and children, while enrollment grew for the adult expansion group, pregnant women, and the elderly. Enrollment in the Adult Expansion Group (AEG) reached 363,032 in November 2025, a peak AEG enrollment, exceeding the highest AEG enrollment level hit in June 2023, before the unwinding. AEG enrollment has increased five months in a row.
There have been significant improvements (drops) in the number of pending applications in the last four months; but the number of pending applications rose in November to roughly 7,800, likely resulting from the increase in applications overall. Nevertheless DSS is still making significant progress on processing applications: the number of days to process an application has dropped to 15 days, the lowest level records by DSS in over two years.
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.
Enrollment in the Adult Expansion Group (AEG) reached 363,032 in November 2025, showing seven months in a row that AEG enrollment has grown, and a peak AEG enrollment, exceeding the peak hit June 2023 before the unwinding period started. The recent rises in AEG enrollment can likely be attributed to several factors. There are continued robust applications to the MOHealthNET program, reflecting need for expansion program (those under 138% of the poverty line); applications have remained near or above 700 per day since the expansion started. But the changes are also possibly attributable in part to churning back onto the program after people lost their coverage, or people choosing the AEG rather than other categories as long as they are eligible for the expansion category.
As noted, the relative stability of the aggregate MOHealthNET enrollment masks shifts 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 (see graph). It is noteworthy that the state 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. AEG enrollment has grown throughout the period 2020-25, as has enrollment in the aged category (see graph). However, the gains in enrollment for children and custodial parents have been offset by drops in enrollment since the unwinding period started. Enrollment in the disability category has dropped since the expansion started, as perhaps some people are choosing to enroll in the AEG category rather than the PTD category.
As noted, applications to Medicaid program rose in November 2025 to almost 29,700. The increase in the number of applications to Medicaid, rising from 23,031 to 29,686 from October to November 2025 reflects the beginning of the open enrollment period for the ACA marketplaces; however, that level of applications is 13% below the number of applications received in November 2024 (33,934). As shown in the graph, applications to Medicaid always rise during the open enrollment period, as people who are looking at coverage for the following year may discover or be told they are eligible for Medicaid rather than an ACA marketplace plan.
There have been significant improvements (drops) in the number of pending applications in the last five months (from over 26,000 in December 2024 to just 7,800 in November 2025 (though there was an increase in November 2025). The drop in pending applications of over 70% from December 2024 is quite notable, suggesting the DSS is making significant progress on processing applications. The average days to complete an application dropped to 15 days in November 2025, a significant drop from 40 days in February 2025.
Non-MAGI applications (for those with disabilities) remain below the levels seen before the Medicaid expansion started, but have remained generally steady since 2022. On average, the number of non-MAGI applications has dropped about 2,300 per month since expansion began in October 2021, and the number of applications approved has dropped roughly 1,600 per month. As noted, the drop in applications for the permanent and total disabled population (PTD) likely reflects recipients choosing to apply in the expansion (AEG) category rather than the disability category. The option of expansion created a new and more straightforward coverage option for adults, including those with disabilities, applying for Medicaid coverage for the first time. Prior to expansion, the only way for a childless adult to obtain coverage was to apply to the permanently and totally disabled (PTD) category. Qualifying for coverage under the PTD category entails a lengthy application process in which an individual must prove a permanent disability, obtaining certification by physicians. Under the Medicaid expansion, a low-income individual with disabilities (under 138% of the FPL) seeking health insurance qualifies for the AEG solely based on their income, so they may decide to forgo the PTD application in favor of applying for Medicaid under expansion as part of the AEG.
The delays in processing non-MAGI applications continues to improve since February 2025 as the number of days pending dropped from 107 in February 2025 to 60 in November 2025, though the two months to process applications is still lengthy. It is also the case that the number of non-MAGI pending applications has risen considerably since May 2025 (see graph); it is unclear why this is happening.
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Report prepared by analysts at Center for Advancing Health Services Policy and Economics Research (CAHSPER). and School of Public Health, Washington University in St. Louis.