Medicaid Losses Are Shifting Patients to Self-Pay: Epic Research 2026
Self-pay patients are rising across every U.S. care setting as Medicaid coverage shrinks, according to a new Epic Research analysis of more than 550 million healthcare encounters. In the second quarter of 2026, 7.6% of emergency department visits were self-paid, up from 5.5% in early 2022, while Medicaid’s ED share fell from 18.2% to 16.1%. The same shift appeared in inpatient care (self-pay 1.9% to 2.6%), births (0.8% to 1.3%), and primary care (1.8% to 1.9%). The trend follows post-pandemic Medicaid redeterminations that dropped more than 25 million people, and is expected to deepen as roughly $1 trillion in Medicaid cuts from the 2025 reconciliation law take effect.
For multi-site operators and finance leaders, a rising self-pay mix means more uncompensated care, higher bad-debt exposure, and collections pressure, especially in emergency and primary care. Groups in Medicaid-heavy markets should stress-test revenue assumptions and tighten point-of-service collections before the next wave of eligibility cuts lands.
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How much has emergency department self-pay risen as Medicaid coverage shrinks?
Self-pay reached 7.6% of emergency department encounters in the second quarter of 2026, up from 5.5% in early 2022, according to Epic Research’s analysis of more than 550 million encounters. Over the same period, Medicaid’s share of ED visits fell from 18.2% to 16.1%, a nearly identical shift.
Is the payer-mix shift limited to emergency departments?
No. Self-pay rose across every setting Epic studied: inpatient admissions climbed from 1.9% to 2.6%, births from 0.8% to 1.3%, and primary care from 1.8% to 1.9%. Medicaid encounters fell in parallel in each setting, including a drop from 23.1% to 21.5% for births.
What is driving the increase in self-pay patients?
Post-pandemic Medicaid redeterminations removed more than 25 million people from the program after continuous-enrollment protections ended in 2023. The trend is expected to intensify as roughly $1 trillion in Medicaid cuts from the 2025 reconciliation law take effect, with the Congressional Budget Office projecting nearly 6 million additional coverage losses over the next decade.