Summary:
Medicaid serves as the primary health coverage program for low-income Americans, covering one in five individuals. States administer these programs within federal guidelines, creating variation in spending and enrollment across states and eligibility groups. Recent legislative changes, including budget reconciliation, are projected to reduce federal Medicaid spending significantly over the next decade. This analysis examines Medicaid spending per enrollee by eligibility group and state in 2023.
What This Means for You:
- Potential reductions in Medicaid spending could impact healthcare access and affordability for low-income individuals.
- State responses to federal funding cuts will determine variations in spending per enrollee and enrollment losses.
- Medicaid expansion states tend to have higher spending per enrollee across eligibility groups due to demographic and policy differences.
- Future budget reconciliation policies may disproportionately affect Medicaid expansion states.
Original Post:
Editorial Note
Originally published in August 2024, this data note was updated on October 6, 2025 with data from 2023, the most current Medicaid data available at the time of this analysis.
Methods
Data: The KFF State Health Facts on spending per full-benefit enrollee use the T-MSIS Research Identifiable Demographic-Eligibility and Claims Files (T-MSIS data). This data note is based on State Health Facts data from CY 2023.
Overview of methods: KFF defined full-benefit enrollees as those who are enrolled in Medicaid for at least 1 month with full-benefits or those who received at least one month of benefits through an alternative package of benchmark equivalent coverage. They may have not actually used any services during this period, but they are reported as enrolled in the program and are eligible to receive services. References to dual-eligible enrollees do not include Medicare Savings Program (MSP) enrollees due to the restriction of data to full-benefit enrollees only.
Spending: Spending was calculated by summing the total spending of all claims per full-benefit enrollee in the T-MSIS claims files.
Extra Information:
Health Provisions in the 2025 Federal Budget Reconciliation Law provides detailed insights into the budgetary aspects and implications for Medicaid eligibility and spending. Additionally, resources such as State Health Facts and Congressional Budget Office (CBO) publications offer further analysis and state-specific data on Medicaid programs and their fiscal impacts.
People Also Ask About:
- What happens if Medicaid expansion is reversed? This could lead to increased uninsured rates and higher healthcare costs for individuals.
- How are Medicaid responsibilities divided between federal and state governments? States administer Medicaid programs, adapting federal guidelines to meet local needs.
- What options exist if someone loses Medicaid coverage? Individuals could explore marketplace plans or employer-sponsored options.
- What demographic groups benefit the most from Medicaid coverage? Children, seniors, and individuals with disabilities constitute primary beneficiary groups.
Expert Opinion:
The projected reductions in federal Medicaid spending underscore a critical juncture for healthcare policy and state fiscal strategies. Balancing fiscal responsibility with expanding healthcare coverage to safeguard vulnerable populations remains a paramount challenge for state administrators and policymakers.
Key Terms:
- Medicaid spending per enrollee
- Federal Medicaid reimbursement
- Medicaid eligibility groups
- Medicaid budget reconciliation
- Healthcare expenditure tracking
- Medicaid federal-state fiscal relations
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