Every State Medicaid Spending, in One Map

Now that tax reform has passed and Americans are about to see higher paychecks, Republicans in Congress are starting to talk about making changes to social welfare programs, specifically Medicare and Medicaid. There’s a lot of confusion and misinformation about these programs, depending on which side of the political aisle you sit. We decided to simplify things and crunched the numbers to create this map of Medicaid expenditures by state.

We got the data directly from the Medicaid and CHIP Payment Access Commission (MACPAC). We adjusted the size of each state according to the relative size of its Medicaid expenses, color-coding each one (dark red for over $50B, dark blue for under $1B). Our map quickly demonstrates where the highest- and lowest-spending states are across the country.

Let’s back up for one second. Medicare and Medicaid are two programs that sound similar, but they work differently. Medicare works like Social Security—it covers anyone over 65 regardless of income. Medicaid, on the other hand, specifically provides health coverage to vulnerable people, like the poor. The federal government pays about half the cost of Medicaid depending on the state. Obamacare encouraged states to expand Medicaid by footing most of the bill. But 19 states didn’t go along, meaning state governments fund Medicare at different levels, which creates wide disparities in the program around the country.

How wide? Several red states immediately jump off the map. There are two main groups: a band stretching along the South from California to Texas and Florida, and a second cluster in the Northeast extending as far West as Illinois. Population size explains most of these numbers, but not all of them. For example, the five largest states by population are California, Texas, Florida, New York and Pennsylvania. These are the top-five Medicaid-spending states too, but in a slightly different order (see the list below). But the 8th biggest in the country, Georgia ($10.28), falls to the 17th place in terms of Medicaid expenditures. We suspect state politics probably play a role in keeping things relatively inexpensive.

The map also has two groups of low expenditure states. The first, concentrated primarily in the Deep South, has many states spending between $5B and $10B on an annual basis. The exceptions are places with several large cities, like Texas ($41.07B) and Florida ($22.46B). Another obvious trend is a massive gap running across the middle of the country, from North Dakota ($1.3B) down to New Mexico ($5.54B). These states appear small on our map because they spend so little money on Medicaid, typically not more than a few billion dollars.

It’s worth pausing for just a second to consider how vastly different Medicaid expenditures are between California ($88.69B) and Wyoming ($637M). No, that isn’t a typo. California spends more on Medicaid than the bottom 25 states in the Union combined. That single budget item is bigger than the entire GDP of Bolivia ($83.5B).

Top 10 States with the Highest Medicaid Expenditures ($ mln)

1. California, $88,694

2. New York, $62,910

3. Texas, $41,068

4. Pennsylvania, $28,220

5. Florida, $22,459

6. Ohio, $22,388

7. Illinois, $20,171

8. Massachusetts, $17,865

9. Michigan, $17,439

10. New Jersey, $15,080

Top 10 States with the Lowest Medicaid Expenditures ($ mln)

1. Wyoming, $637

2. South Dakota, $875

3. North Dakota, $1,303

4. Montana, $1,446

5. Vermont, $1,768

6. Idaho, $1,795

7. Alaska, $1,929

8. Delaware, $2,003

9. New Hampshire, $2,077

10. Nebraska, $2,093

The most important takeaway from all this information is that Medicaid has 50 different implementations, depending on the state. It might be a massive part of the budget, or it could be a minor allocation worth only several hundred million dollars.

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