Which states spend the most money on Medicaid?

Medicaid provides coverage of health and long-term care for low-income adults, pregnant women and children, as well as the disabled. The program is financed jointly by the federal government and the states with the latter administer of the services providing certain mandatory benefits under national guidelines. However, states may choose optional services and expand eligibility to other optional groups and for which they also receive federal funding.

The federal government’s share of spending on eligible recipients is at least 50 percent of a state’s qualifying expenditure. But under a formula, states with lower per capita incomes receive a higher matching rate of their costs from the federal government, as high as 78 percent in 2022.

Which states spend the most on Medicaid

Given all the variables, spending on Medicaid varies widely across the US. Especially given that twelve states still have not implemented the expansion of the Affordable Care Act (ACA) which would make more of their residents eligible for Medicaid.

In total, more than $672 billion was spent on Medicaid in 2020 representing roughly $1 out of every $6 spent on health care in the US. The states that spent the most overall on Medicaid in 2020 were not necessarily the ones who spend the most per person.

Top five highest Medicaid expenditure in FY 2020

The five states with the highest total outlay on their programs are California, New York, Texas, Pennsylvania and Florida tied with Michigan. Neither Florida nor Texas have implemented the expansion of the ACA.

Top five per capita Medicaid expenditure in FY 2020

There is only one state, Pennsylvania, that is in the top five of highest per capita spending on Medicaid. That list includes from highest to lowest North Dakota, Rhode Island, Pennsylvania, Minnesota and the District of Columbia in the 2020 fiscal year.

Bottom five per capita Medicaid expenditure in FY 2020

Of the states that spend the least per capita on Medicaid, Nevada is the only one which has implemented the ACA expansion. The five states that spend the least per capita, from lowest to highest, are South Carolina, Georgia, Florida, Alabama and Nevada.