National Medicaid enrollment topped 84 million lives in June 2021, according to the latest update to AIS’s Directory of Health Plans. That’s an overall increase of 14.0% from the first quarter of 2020, a highly unusual growth pattern spurred by the COVID-19 pandemic. In 2019, Medicaid enrollment was on a downswing for the first time since the introduction of Medicaid expansion via the Affordable Care Act, but high unemployment rates fueled by the pandemic and the suspension of states’ redetermination efforts caused enrollment to soar in all 50 states, with an average enrollment increase of 16.0% per state. Twelve states saw Medicaid enrollment climb by more than 20%. Even with enrollment up nationwide, Medicaid expansion is still a hot topic in states that have yet to adopt it now that President Biden has offered enhanced funding as part of the American Rescue Plan. And while ballot initiatives are picking up in holdout states, a Missouri judge on June 23 struck down the state’s voter-approved expansion as unconstitutional. Meanwhile, Oklahoma began enrolling newly eligible expansion adults on June 1 for a July 1 effective coverage date, despite the state Supreme Court’s decision to excise managed care from the transformation effort.