Changes in Medicaid and Marketplace Enrollment in Missouri by County, and Rural/Urban Status, 2023-2025

by Claire Ami Pavlides, MPH Candidate; Sarah A. Eisenstein, PhD; and Timothy D. McBride, PhD, MS | October 2025

In 2023-2025, Missouri experienced significant shifts in health insurance coverage, with a marked decline in Medicaid enrollment – primarily affecting those with incomes near the poverty line – and a simultaneous increase in Marketplace enrollment. These changes reflect broader national trends following expiration of pandemic-era protections, particularly the continuous Medicaid coverage requirement, which temporarily prevented disenrollment. As eligibility reverifications resumed in 2023, many individuals who lost Medicaid coverage likely sought alternative health insurance options, with some of them seeking coverage through the ACA Marketplace. This analysis examines the percentage change in Medicaid and Marketplace enrollment across Missouri counties, highlighting key patterns and differences.