How has Medicaid enrollment among Somali Minnesotans changed since 2020 and what factors drove it?
Executive summary
Medicaid enrollment in Minnesota rose sharply during the COVID-era continuous enrollment period and remained above pre‑pandemic levels after federal unwinding; Minnesota had about 1.17 million people on Medicaid in mid‑2025 and enrollment was 33% higher in mid‑2025 than in fall 2013, with pandemic policies and later eligibility redeterminations driving the biggest shifts [1] [2]. Available sources do not provide a precise, separately tracked count of “Somali Minnesotans” on Medicaid over time or a numeric change in Medicaid enrollment specifically for Somali residents (available sources do not mention a Somali‑specific enrollment series).
1. Pandemic pause and the big bump: continuous enrollment kept people on Medicaid
When COVID struck, the federal Public Health Emergency triggered a continuous enrollment rule that effectively paused routine Medicaid disenrollments from March 2020 through the pandemic years. That policy produced a nationwide enrollment surge and higher baseline in Minnesota when states later resumed eligibility checks; KFF notes Medicaid/CHIP enrollment nationally is still 8% above February 2020 levels, and Minnesota’s overall Medicaid numbers grew dramatically during that period [3]. Minnesota’s state reporting and KFF fact sheets show Minnesota’s program remained substantially larger than its pre‑pandemic size into 2025 [2] [1].
2. Unwinding and redeterminations: a forced drop and churn
The return to normal eligibility redeterminations in 2023–2024 led to widespread disenrollments across states. HealthInsurance.org summarizes that Minnesota’s enrollment had been higher during the pandemic when disenrollments were paused, then many people were disenrolled when eligibility was redetermined in 2023 and 2024 — a major driver of post‑pandemic enrollment change [2]. KFF’s unwinding tracker documents the same national pattern: February 2020 is the baseline; later months show declines as states processed renewals [3].
3. Longer‑term expansion and structural growth: Medicaid expansion raised the ceiling
Minnesota expanded Medicaid under the Affordable Care Act well before the pandemic; that expansion explains much of the program’s long‑run growth. HealthInsurance.org states Minnesota’s Medicaid enrollment in mid‑2025 was 33% higher than in fall 2013, with expansion cited as the primary cause of that multi‑year increase [2]. The federal government’s enhanced match for expansion populations and state policy choices created a larger eligible population entering the pandemic period [4] [2].
4. Why Somali Minnesotans figure in the public debate — but data are thin
Recent political and media attention on Minnesota’s Somali community — including federal enforcement plans and allegations of fraud — has focused public attention on Somalis’ use of public benefits, yet the sources available here do not provide Somali‑specific Medicaid enrollment data [5] [6]. News reports describe investigations and allegations tied to segments of the community, and some outlet commentary connects fraud cases to Somali‑owned firms, but those reports are not the same as population‑wide enrollment statistics and do not quantify how enrollment changed among Somali Minnesotans [7] [8].
5. Competing narratives: public‑safety framing vs. institutional explanations
Reporting and opinion differ on causes. State and national health data attribute most enrollment shifts to policy changes — Medicaid expansion, pandemic continuous enrollment, and subsequent redeterminations — rather than to demographic shifts tied to any single community [4] [2] [3]. Other commentators and some conservative outlets emphasize fraud cases tied to specific providers and allege broader misuse by Somali networks; those pieces cite prosecutions and program weaknesses but do not establish population‑level enrollment trends for Somali Minnesotans [7] [8]. Both storylines appear in the sources provided; neither set supplies a Somali‑specific enrollment time series [2] [7].
6. What the data allow — and what they don’t
State and KFF trackers allow robust statements about total Minnesota Medicaid enrollment trends (numbers of enrollees, pandemic impacts, and the effect of redeterminations) — for example, roughly 1.17 million Minnesotans were enrolled as of mid‑2025 and enrollment is far above 2013 levels due mainly to expansion and pandemic policies [1] [2]. Available reporting, however, does not break out Medicaid enrollment by detailed ancestry groups such as Somali Minnesotans, nor does it provide a validated time series isolating the Somali population’s enrollment changes since 2020 (available sources do not mention Somali‑specific enrollment time series).
7. Bottom line for readers and policymakers
Policy changes — Medicaid expansion, the COVID‑era continuous enrollment, and the 2023–24 redeterminations — explain almost all of Minnesota’s Medicaid enrollment swings documented in the sources [4] [2] [3]. Allegations and prosecutions involving some Somali‑linked providers have shaped political rhetoric and sparked federal action, but the sources here do not support a claim that Somali Minnesotans as a group were the primary driver of statewide Medicaid enrollment changes (available sources do not mention Somali‑specific enrollment trends) [7] [5]. Policymakers must distinguish discrete criminal cases from population‑level program trends when weighing reforms; the published data cited do that for Minnesota’s total enrollment but not for specific ethnic subgroups [2] [3].