Measures That Drive State Medicaid per Enrollee Spending

Medicaid is the primary program providing comprehensive health and long-term care to one in five people living in the U.S and accounts for nearly $1 out of every $5 spent on health care. Medicaid is jointly financed by states and the federal government, but states administer Medicaid programs within broad federal rules. Under federal law, Medicaid provides an entitlement to coverage to individuals who are eligible for the program and a guarantee to federal matching dollars for states. State Medicaid policy choices (including the ACA Medicaid expansion, eligibility levels for other populations, reimbursement rates, and delivery system models) as well as other factors such as population demographic characteristics, health needs of Medicaid enrollees, state fiscal capacity, and health care costs affect Medicaid spending. As a result, Medicaid coverage and financing vary significantly across states. 

This data collection pulls together metrics that contribute to variation in Medicaid per enrollee spending. It provides data and information on Medicaid program and policy characteristics, and also includes measures of population demographics, health status of Medicaid enrollees, available revenue and state budget choices, and health care costs and access to care that drive demand for Medicaid and affect states’ ability to raise revenue or reduce spending. The Congressional Budget Office estimates the 2025 reconciliation law will reduce federal Medicaid spending by $911 billion over the next decade. The reduction in federal Medicaid spending may intensify state budget pressures.