Medicaid Enrollment Declines as 'Big Five' Companies Reassess Market Participation

The 'Big Five' companies in the Medicaid managed care market, Centene Corporation, CVS Health/Aetna, Elevance Health, Molina Healthcare, and UnitedHealth Group, have reported their Q2 results for the calendar quarter ending June 30. The total Medicaid enrollment in these five companies has dropped from 36.2 million on June 30, 2025 to 34.0 million on June 30, 2026, a decline of 6.5 percent.

The decline is consistent with the overall trend in Medicaid enrollment, which has fallen by 5.3 percent since July 2025. All five companies experienced enrollment declines over the past four quarters, ranging from 2.6% for CVS Health/Aetna to 9.5 percent for UnitedHealth Group.

Elevance Health is taking a more drastic approach to mitigate its losses. In early Q3 earnings calls, CEO Gail Boureaux announced that the company would exit some Medicaid markets where it does not see a path to sustainable performance. Elevance has already reached a mutual agreement with the District of Columbia to exit the DC Medicaid market.