States with the Most and Least Medicaid Coverage

As of November 2019, over 64 million individuals were enrolled in Medicaid. The Trump administration announced an overhaul to the system at the end of January. This change would allow states to cap the amount of Medicaid funds they receive from the Federal Government. Proponents of this change say it will eliminate waste and save money while opponents say it will limit access for people who need it.

Medicaid is also an important issue in the upcoming 2020 election. Democratic hopefuls not only differ from President Trump but also from each other on the matter. For example, Joe Biden’s plan says that he supports the expansion of Medicaid and the ACA as a whole. Bernie Sanders, on the other hand, supports “Medicare for all,” which could complicate the status of Medicaid. But Medicaid isn’t just in the news due to the upcoming election – as the threat of coronavirus looms, Vice President Pence has confirmed that Medicaid will cover tests for the disease.

Regardless of partisan ideas about how expansive Medicaid should be as a whole, it’s a fact that some states rely on Medicaid coverage more than others do. To find out the states where Medicaid is most prevalent, WalletHub compared the 50 states across 12 key metrics in three overall categories. Our data set ranges from total Medicaid spending per low-income population to adult care quality and children Medicaid eligibility level. Read on for our ranking of the states, additional commentary from a panel of experts, and a complete description of our methodology.

Main Findings

Medicaid Coverage by State

Total Medicaid Spending per Low-income Population Over Time

Ask the Experts

Medicaid is one of the most well-known examples of government assistance in the U.S., with a large chunk of the population enrolled. As the government considers how much to expand or limit Medicaid coverage, we turned to a panel of experts for additional insight. Click on the experts’ profiles below to see their bios and answers to the following key questions:

1. What are the major benefits and drawbacks of Medicaid expansion?
2. Nationally, there are two million poor uninsured adults that fall into the “coverage gap” resulting from state decisions not to expand Medicaid. What are the best options to consider for an individual that does not qualify for Medicaid?
3. In a recent study, Medicaid expansion has been shown to improve access to care, affordability of care, and financial security among the low-income population, however, 14 states are currently not expanding Medicaid. What measures can local authorities take in order to ensure healthcare access for the vulnerable population?
4. Given the fact that a growing number of states seek to establish work requirements in their Medicaid programs, what is your opinion on this matter and how does it affect the disadvantaged population?

Methodology

In order to determine the states with the most and least Medicaid coverage, WalletHub compared the 50 states across three key dimensions, “Spending,” “Quality,” and “Eligibility & Enrollment.”

We evaluated those dimensions using 12 relevant metrics, which are listed below with their corresponding weights. Each metric was graded on a 100-point scale, with a score of 100 representing the highest level.

We then determined each state’s weighted average across all metrics to calculate its overall score and used the resulting scores to rank-order our sample.

Spending – Total Points: 33.33

• Total Medicaid Spending Per Low-income Population: Double Weight (~11.11 Points)
• Change in Total Medicaid Spending (2018 vs 2010): Full Weight (~5.56 Points)
• State vs. Federal Medicaid Contribution: Full Weight (~5.56 Points)
• State Medicaid Spending as Share of State Budget: Full Weight (~5.56 Points)
  Note: This metric measures the total Medicaid & state-funded Medicaid spending as share of total state budget.
• Life Expectancy for Low-income Individuals: Full Weight (~5.56 Points)

Quality – Total Points: 33.33

• Adult Care Quality : Full Weight (~11.11 Points)
  Note: This metric measures performance rates on frequently reported health care quality measures in the CMS Medicaid Adult Core Set.
• Medicaid Denial Rate for In-Network Claims by Healthcare.gov Issuers: Full Weight (~11.11 Points)
• Transparency in Reporting Quality Measures: Full Weight (~11.11 Points)
  Note: This metric measures the share of voluntarily reported sets of core measures showing the quality of care and health outcomes for adults participating in Medicaid, and children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP).

Eligibility & Enrollment – Total Points: 33.33

• Children Medicaid Eligibility Level: Full Weight (~6.67 Points)
  Note: This metric is expressed as a percentage of the Federal Poverty Level.
• Pregnant Women Medicaid Eligibility Level: Full Weight (~6.67 Points)
  Note: This metric is expressed as a percentage of the Federal Poverty Level.
• Adults Medicaid Eligibility Level : Full Weight (~6.67 Points)
  Note: This metric is expressed as a percentage of the Federal Poverty Level.
• Total Medicaid Enrollment per Low-income Population: Double Weight (~13.33 Points)

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Sources: Medicaid and CHIP Payment and Access Commission, Kaiser Family Foundation, Health Inequality Project and Centers for Medicare & Medicaid Services.