Key findings from Wolfe Research
Wolfe Research reported that Elevance Health (NYSE:ELV) is projecting the most conservative Medicaid enrollment change for 2026 at negative 8%, based on its updated state-level membership analysis covering March and April data. The firm's tracker points to continued attrition across the state programs monitored.
State data and monthly trends
For states with updates through March, Wolfe found membership fell by 72 basis points during the month, compared with declines of 57 and 58 basis points in January and February, respectively. For April, the subset representing 18% of measured enrollment showed a 37 basis-point decline versus a 30 basis-point decline in March.
Among the 11 states that provided April data, Arkansas and Indiana registered the steepest month-over-month drops at negative 2.0% each, while New Jersey posted growth of 0.7% for the third month in a row.
Company-level year-to-date enrollment estimates
Using current trends and each company's Medicaid state footprint, Wolfe estimates year-to-date enrollment declines as follows:
- Elevance Health: negative 1.7%
- Centene: negative 1.9%
- Molina Healthcare: negative 1.3%
- UnitedHealth Group: negative 1.0%
- CVS Health: negative 1.8%
- Humana: negative 1.3%
Guidance revisions and company commentary
Molina Healthcare raised its same-store attrition guidance to 6% from 2%, attributing the change to experience in California, Illinois, New York and Texas. Wolfe notes this level of attrition aligns with Centene's roughly 6% year-over-year guidance and Elevance's high single-digit range for attrition.
First-quarter commentary from major Medicaid participants pointed to a degree of stabilization, but overall attrition remains below historical trend. Broadly, companies expect around 4% attrition. Molina indicated first-quarter annualized figures could come in below 5%, while Centene reported a mid-4% net trend. Wolfe summarized reported fiscal-year or composite rates as: Molina at 4% for the fiscal year, Centene at 4.5% composite, Elevance close to mid-single digits yet slightly below trend, and UnitedHealth describing current funding as insufficient.
Analytical perspective and data scope
The tracker aggregates state-reported membership updates, and the coverage for April represents 18% of the measured enrollment. Wolfe's company estimates are derived from applying the observed state-level trends to each insurer's geographic Medicaid footprint. The firm’s data show variability across states and among insurers, with some states reporting month-to-month growth while others post multi-percentage-point declines.
Because the April dataset includes updates from only 11 states, the monthly results for that period reflect a partial view of total national enrollment. Wolfe's conclusions and the companies' guidance reflect these observed trends within the available state reporting.