Payer Pulse: The Medicaid Landscape

The finding · written 4 August 2026

The smallest Medicare Advantage payer of the four is the largest Medicaid payer in the country.

Medicaid members at July 2024 against Medicare Advantage members today (each source's newest)

Report 01 shows that ranking these four companies by Medicare Advantage and by standalone drug plans produces two opposite orders. Add Medicaid and the pattern repeats a third time. Centene runs under a million Medicare Advantage members and just over twelve million Medicaid members, nearly one in five of everyone enrolled in a comprehensive Medicaid plan. Humana, whose business is mostly Medicare, is the smallest of the four here. Whatever these companies look like from the Medicare side, this is the larger share of what three of them actually do: government programs, at scale, under state contracts.

The book at the top was not grown so much as assembled. The steps visible in Panel 01 are acquisitions: Fidelis Care closed on July 1, 2018, the exact day of that year's snapshot; Meridian followed that September; WellCare in January 2020. Then a pandemic-era rule barred states from removing anyone from Medicaid for three years, carried every company's book to a 2022 or 2023 peak, and the resumption of eligibility checks took a full year of growth back. The notes work through both halves.

Scope: comprehensive Medicaid managed care only, from CMS's annual July snapshots, of which 2024 is the newest published. Dental, transport and behavioral-health carve-outs are excluded, and company filings count members this report does not, so their figures run higher. Same four companies as Report 01, chosen to match it: Elevance and Molina also run multi-million-member Medicaid books and are absent here.

Medicaid enrollment by company

Panel 01

Comprehensive Medicaid managed care members by parent company at each July 1 snapshot, rolled up from CMS's plan-level file across every state program. Attribution follows ownership at the time: WellCare's members count toward Centene only from 2020, Aetna's toward CVS Health only from 2019. Sub-brands roll up to their parent, as in Report 01: Fidelis, Meridian, Health Net and Sunshine State to Centene, Aetna Better Health to CVS Health. The chart begins in 2017 because CMS's 2016 file carries no parent-company data; the national series in Panel 03 reaches back to 2016.

Annual data with a long lag: CMS published the July 2024 snapshot in February 2026, and no fresher public plan-level source exists. A company's own filings will read higher than these lines, sometimes by more than a million members, because filings also count separate CHIP programs and specialty contracts outside comprehensive managed care. That gap is definitional, not an error.

Where the books live

Panel 02

Each company's largest state books at the July 2024 snapshot, with July 2022 alongside: the two years bracket the unwinding. Centene's three largest books, California, New York and Florida, are Health Net, Fidelis and Sunshine State, and all three arrived by acquisition.

CMS publishes these rows as state programs report them, and small cells are sometimes masked. Territories are included: Humana's Puerto Rico plan appears throughout its history here.

Company

The national tide

Panel 03

Everyone in a comprehensive Medicaid plan, all parent companies, 2016 to 2024. The flat years end in 2020: pandemic-era rules barred states from removing anyone from Medicaid for three years, and enrollment climbed 21 million. Eligibility checks resumed in mid-2023, and the July 2024 snapshot is down 8.5 million in a single year. Monthly state-level data published since shows the decline continued past this snapshot.

This series reconciles to CMS's own state-by-state summary table within a sixth of one percent in every year, always slightly under: CMS masks plan rows of ten or fewer members, and this page is built from the plan rows.

Analyst notes

Read alongside

Observations about an industry, not investment advice.