Medicaid fee-for-service is in a steep decline, and signs suggest trends will continue in their current direction, a new report reveals.

In 2014, the number of Medicaid beneficiaries on a private managed care plan increased by 9.3 million, while those in traditional fee-for-service enrollment dropped by 300,000, a Pricewaterhouse-Coopers report found. The proportion of beneficiaries in private managed care jumped from 59% to 66%.

Overall, the trend represents a “tipping point” for managed Medicaid, report analysts stated.

California continues to lead the nation in the number of Medicaid beneficiaries at 10.3 million, while Wyoming, the state with the smallest population, also enrolls the fewest in Medicaid at 70,000. Unchanged from last year are the states with the greatest percentage of the population enrolled in Medicaid, the District of Columbia (now up to 38%), and the smallest, Utah (holding at 9%). 

Nevada increased coverage by the greatest percentage of its population (10.1%); other states also posted changes in coverage in excess of 7% — Colorado, Rhode Island, Connecticut, Kentucky, West Virginia and Oregon.

A separate Avalere Health analysis said the percentage of people in managed care plans in states that expanded Medicaid will rise to 79% in 2016.