Medicaid Enrollment Data Underscore the Need for OBBBA Reforms

New enrollment data strengthen the case for Medicaid and CHIP integrity reforms in H.R. 1, the “One Big Beautiful Bill Act.” New data from the Kaiser Family Foundation (KFF) show that 74.9 million people were enrolled in Medicaid and CHIP in February 2026, about 3.5 million more than in February 2020, the month before the pandemic.

That figure complicates the familiar claim that Congress is gutting Medicaid. The program remains larger than it was before COVID, even after states completed much of the post-pandemic enrollment unwinding. A program of that size needs accurate eligibility checks, stronger oversight, and serious protection against waste, fraud, and abuse.

Medicaid Remains Above Its Pre-Pandemic Baseline

Medicaid enrollment surged during the pandemic after Washington paused normal eligibility reviews. States kept beneficiaries on the rolls for years, even when income, residency, household status, or other eligibility facts may have changed.

The unwinding process reduced enrollment from its emergency-era peak, but the program has not returned to its pre-pandemic baseline. KFF’s data show Medicaid and CHIP enrollment remains about 5 percent higher than before COVID.

The gap points to a program still carrying pandemic-era enrollment growth, even after the formal emergency ended. Medicaid was designed to serve low-income families, children, pregnant women, seniors, and people with disabilities. Maintaining accurate eligibility records and regularly confirming who qualifies are basic responsibilities in a program that serves nearly 75 million people.

OBBBA Restores Basic Program Integrity

The Congressional Research Service summary of H.R. 1 outlines several provisions aimed at improving Medicaid and CHIP program integrity.

The bill would strengthen address verification and create a federal system to reduce the risk of people being enrolled in Medicaid or CHIP in more than one state. It would require more frequent eligibility redeterminations for certain Obamacare expansion adults. It would also tighten verification rules for citizenship, nationality, or satisfactory immigration status before federal Medicaid or CHIP funds are used.

The provisions largely focus on verifying eligibility, preventing duplicate enrollment, and improving oversight of federal spending. As Medicaid enrollment remains well above its pre-pandemic level, Congress has a legitimate interest in ensuring that benefits are reaching people who qualify under the law.

Public dollars should not support duplicate enrollment, stale eligibility records, or benefits for individuals who no longer qualify.

Work Requirements Focus Medicaid on the Truly Needy

H.R. 1 would establish community engagement requirements for certain able-bodied, childless adults on Medicaid. CRS notes that the requirement would apply to specified nonpregnant, nondisabled adults ages 19 through 64, while preserving exemptions for medically frail individuals, people with serious health needs, certain caretakers, foster youth, and other protected groups.

That approach draws a reasonable line. Medicaid should remain available for vulnerable Americans who need help. Able-bodied adults who can work, train, study, or volunteer should face a basic expectation of participation.

Work requirements are not an attack on Medicaid. They are a way to preserve Medicaid for the people the program was built to serve.

Waste and Fraud Policing Protects Taxpayers

The debate over Medicaid reforms often centers on coverage losses, but many of the provisions in H.R. 1 are aimed at eligibility verification and program oversight rather than changes to core benefits.

Removing ineligible people from the rolls is not a cut to Medicaid. Blocking duplicate enrollment is not a cut to Medicaid. Verifying basic facts before federal dollars leave the Treasury is not a cut to Medicaid.

Those reforms protect patients and taxpayers at the same time. Every dollar lost to improper enrollment, weak verification, or fraud is a dollar diverted from vulnerable Americans who depend on Medicaid for care.

A Broader Push to Clean Up Medicaid

The OBBBA Medicaid reforms fit a broader Trump-era push to right-size federal health programs and drive corruption out of the system.

CFE recently praised a new CMS proposed rule that would rein in Medicaid payment abuses, strengthen oversight of state directed payments, and save taxpayers more than $775 billion over 10 years. CFE has also highlighted Dr. Mehmet Oz’s crackdown on hospice fraud, including CMS action against roughly 800 hospices that billed taxpayers $1.4 billion last year.

The same principle applies across these fights. Medicaid should protect eligible patients and families, not reward weak eligibility checks, inflated payment schemes, or fraud. OBBBA’s eligibility, work requirement, and program integrity provisions are part of the same needed correction.

CFE Takeaway

Medicaid and CHIP enrollment remains millions higher than before the pandemic. That should end the claim that basic eligibility enforcement is extreme.

H.R. 1 brings needed discipline to a program that expanded sharply during the COVID emergency and still has not returned to its pre-pandemic baseline. Congress should enforce eligibility rules, apply reasonable work requirements for able-bodied adults, and police waste, fraud, and abuse across Medicaid and CHIP.

Medicaid should protect the truly needy, not preserve pandemic-era enrollment practices forever.