The Medicaid and CHIP snapshot released by the Centers for Medicare & Medicaid Services on August 28, 2026 should be required reading for social-work leaders. It shows not only who is covered, but how administrative systems produce coverage loss.
In May 2026, 73.5 million people were enrolled in Medicaid and CHIP: 66.4 million in Medicaid and 7.1 million in CHIP. That included 38.3 million adults and 35.2 million Medicaid-enrolled children and CHIP participants. Another 1.6 million people were enrolled in a Basic Health Program or related state program.
The trend is downward. Between May 2025 and May 2026, Medicaid enrollment fell by 4.4 million people, or 6 percent. CHIP enrollment declined by roughly 150,000, or 2 percent. Child Medicaid and CHIP enrollment fell by approximately 2 million, while adult Medicaid enrollment dropped by 2.6 million.
Those figures are not simply a measure of changing eligibility. They are also a measure of administrative burden.
The renewal funnel
CMS reports that 5.7 million people were due for renewal in May. Sixty-eight percent retained coverage, 19 percent were disenrolled, and 13 percent remained pending at month’s end. Forty-eight percent were renewed automatically through ex parte processes that use existing government data. Fifteen percent were disenrolled for procedural reasons, compared with 5 percent determined ineligible based on a returned form.
That distinction is fundamental. A procedural disenrollment does not establish that the person lacked eligibility. It often means paperwork was not received, a notice went to the wrong address, documentation was incomplete, a deadline was missed, or an agency failed to resolve information in time.
National averages also conceal enormous state variation. CMS found overall renewal retention rates ranging from 16 to 90 percent. Ex parte renewal ranged from 7 to 82 percent. Disenrollment ranged from 7 to 47 percent, while procedural disenrollment ranged from 4 to 46 percent.
A national program should not expose an eligible person’s access to healthcare to such radically different administrative odds depending on residence.
Administrative burden as policy
Political scientist Pamela Herd and sociologist Donald Moynihan describe administrative burden through three costs: learning costs, compliance costs, and psychological costs. Medicaid renewal contains all three.
People must understand notices and changing rules. They must gather documents, navigate portals, call agencies, attend appointments, and respond within deadlines. They may also experience stigma, confusion, fear, and the stress of losing medication, therapy, home-care services, or a trusted physician.
Social workers routinely absorb these costs on behalf of clients. They interpret letters, help replace identification, upload documents, contact eligibility offices, and rebuild care plans after coverage lapses. Yet agencies rarely count that labor as part of Medicaid administration. It appears in case notes, crisis calls, hospital discharge delays, and uncompensated advocacy—not in the eligibility-system budget.
The August snapshot also shows rising demand at the front door. States and related agencies received 2.7 million applications in May, 5 percent more than in April and 15 percent more than in May 2025. Seventy-two percent of MAGI applications were processed within seven days, but 5 percent took longer than the 45-day regulatory standard. Twenty-two states were at or above that national long-delay rate.
What reform should look like
First, states should maximize ex parte renewal. If an agency can verify eligibility through wage, tax, SNAP, or other reliable data, it should not require a person to prove the same facts again.
Second, procedural terminations should trigger outreach before closure. Text messages, telephone calls, translated notices, community partners, and data matching should be used before benefits end.
Third, CMS should establish a procedural-discontinuance performance threshold. A state with a rate approaching 46 percent should face corrective action, technical assistance, and transparent monitoring.
Fourth, Medicaid contracts should fund community-based enrollment and renewal support. Social-service organizations cannot be expected to perform eligibility repair indefinitely without reimbursement.
Fifth, social-work education should treat benefits administration as a core practice and policy competency. Students should learn how digital systems, documentation rules, and bureaucratic discretion shape health outcomes.
Sixth, states should measure reinstatement. A person who regains coverage shortly after procedural termination likely experienced preventable churn. That churn should be counted as system failure, not a successful case closure.
The profession’s responsibility
Social work often frames Medicaid advocacy around preserving eligibility categories and benefit levels. Those battles matter. But formal eligibility means little when administration prevents people from maintaining coverage.
The August 28 snapshot reveals a system in which 15 percent of people due for renewal were terminated for procedural reasons during a single month, while state rates varied dramatically. That is not clerical background noise. It is a distributive decision about who receives healthcare.
The Social Work Reformer’s position is straightforward: administrative design is social policy. When millions lose coverage and procedural closures outnumber determinations of ineligibility three to one, reform cannot stop at helping clients complete one more form. Social workers must demand systems that do not manufacture need through preventable bureaucracy.
Selected sources
Centers for Medicare & Medicaid Services, “May 2026 Medicaid and CHIP Eligibility Operations and Enrollment Snapshot,” released August 28, 2026:
https://www.medicaid.gov/resources-for-states/downloads/eligib-oper-and-enrol-snap-may2026.pdf
CMS, monthly Medicaid and CHIP applications, eligibility, and enrollment reports:
https://www.medicaid.gov/medicaid/national-medicaid-chip-program-information/medicaid-chip-enrollment-data/monthly-medicaid-chip-application-eligibility-determination-and-enrollment-reports-data
Herd, P., and Moynihan, D. P., Administrative Burden: Policymaking by Other Means:
https://www.russellsage.org/publications/administrative-burden