Medicaid is the primary program providing comprehensive health and long-term care coverage to approximately one in five low-income Americans. States administer Medicaid programs within broad federal rules, but have adaptability in designing programs, wich creates variation in spending and enrollment and also spending per enrollee across eligibility groups and states.
Over the coming years,state Medicaid programs may see significant reductions to their Medicaid enrollment and spending,resulting in changes to their spending per enrollee,across eligibility groups due to the recently enacted budget reconciliation package once called the “One Big,Stunning Bill,” signed by president Trump on July 4th.The new law is estimated by the Congressional Budget Office (CBO) to cut federal Medicaid spending by $911 billion – or 14% of federal medicaid spending – over the next ten years and increase the uninsured rate by 10 million with some of the increase attributed to individuals losing medicaid coverage. Provisions in the new law will have different effects on Medicaid spending and enrollment across the states.For example,over half of the reductions in federal spending (associated with most of the projected enrollment declines) stem from policies that only would affect states that have expanded Medicaid under the Affordable Care Act (ACA). How states respond to reductions in federal funding will impact the amount of spending reductions and the distribution of enrollment losses, which will affect Medicaid’s spending per enrollee.
This data note provides an overview of total Medicaid (state and federal shares) spending per enrollee for full-benefit Medicaid enrollees by eligibility group and state in 2023. Data from 2023 are the most current Medicaid data available at the time of this analysis. Full-benefit Medicaid enrollees are those that qualify for a full range of Medicaid services such as doctor’s visits, hospitalizations, prescription drugs, and home health services. A small number of total enrollees (8% of all enrollees in 2023) qualify for only a limited set of Medicaid benefits such as family planning or treatment of an emergency medical condition and are not included in this analysis. References to Medicaid enrollees in this data note refer to full-benefit enrollees.See methods for more details.Detailed state-level data are also available on State Health Facts.
Medicaid Spending Varies Considerably Across States and Eligibility Groups
Per-enrollee spending in Medicaid varies considerably across states, ranging from $5,040 in Florida to $57,900 in Minnesota (Figure 3).States have considerable discretion in determining the populations and services covered for long-term care (LTC), leading to significant variation in per-enrollee spending for older adults and individuals with disabilities,who are more frequent users of LTC. In comparison, per-enrollee spending for children ranges from $2,227 in Alabama to $5,457 in Alaska (Figure 3). All states are required to provide comprehensive coverage for children through the Early Periodic Screening Diagnosis and Treatment (EPSDT), which contributes to less variation in per-enrollee spending for this group.
Many-but not all-states with relatively high or low overall per-enrollee spending exhibit similar patterns across eligibility groups (Figure 3). Some states with the lowest overall per-enrollee spending (e.g., Alabama, Oklahoma) also have the lowest per-enrollee spending for most eligibility groups (Figure 3). Others, such as Florida and Nevada, show more mixed results across eligibility groups. As a notable example, Florida has low per-enrollee spending across all eligibility groups except for children, where it is indeed among the highest.Similarly, states with the highest overall per-enrollee spending (e.g., Washington, D.C., Delaware) generally have the highest spending for all eligibility groups. However, states like Pennsylvania and Massachusetts are less consistently high across all eligibility groups (Figure 3).
Even within a given state and eligibility group, there is wide variation in spending (Table 1). For example, among people with disabilities in Virginia, 25% have spending less then $12,506 and 5% have spending more than $130,130 – ten times higher (Table 1). Additionally, 25% of seniors in Colorado have spending less than $1,817, and 25% have spending sixteen times greater ($29,406) (Table 1). Despite the generally lower costs for non-disabled adult and child enrollees, the variation in spending for these eligibility groups is also substantial.