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U.S. states with the highest Medicaid expenditure 2018

Total Medicaid spending surpassed 590 billion U.S. dollars in 2018. The state of California had the highest expenditure throughout the year, followed by New York and Texas.

Federal government helps poorer states

Both the federal and state governments fund the Medicaid health care program, but at least 50 percent of the costs incurred by states are matched by the federal government. The exact percentage varies by state because the matching rate was designed so that poorer states receive a larger share of program costs from the federal government. The states of North Dakota, South Dakota, and Wyoming spent the least on Medicaid costs in 2018.

Funding share of states set to increase

Under the Affordable Care Act, states have the choice to expand their Medicaid programs to cover nearly all low-income Americans under age 65. For states that implemented the expansion, the federal government paid 100 percent of the state costs for all newly eligible adults from 2014 to 2016. The new matching rate has slowly declined since and reached 90 percent in 2020, which means states have to pick up ten percent of the bill. Governors are concerned about the rise in costs, and state expenditure is projected to increase by 50 percent between 2020 and 2027.

U.S. states with the highest Medicaid expenditure in FY 2018 (in billion U.S. dollars)*

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Sources

Release date

August 2019

Region

United States

Survey time period

fiscal year 2018

Supplementary notes

Expenditures do not include administrative costs, accounting adjustments, or the U.S. Territories. Total Medicaid spending including these additional items was $616 billion in FFY 2018.
Unless otherwise noted, years preceded by "FY" on statehealthfacts.org refer to the Federal Fiscal Year, which runs from October 1 through September 30. For example, FY 2014 refers to the period from October 1, 2013 through September 30, 2014.

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Statistics on "Medicaid/CHIP"

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