Measures to Identify States at Greater Risk if Federal Medicaid Spending Is Reduced

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. Restrictions in federal Medicaid spending that are currently being debated in Congress could leave states with tough choices about how to offset reductions through cuts to Medicaid, cuts to other programs, or tax increases. The metrics below can be used to identify states that may be at higher risk if federal Medicaid funding is reduced or if other changes to Medicaid financing are made. For more information on KFF’s analysis of states at risk, see Responding to Federal Medicaid Reductions: Which States Are Most at Risk?