States with the Most and Least Medicaid Coverage

Having reliable and affordable healthcare is more important now than ever as the U.S. faces the COVID-19 pandemic, and as of September 2020, over 70 million individuals were enrolled in Medicaid. President Joe Biden is also looking to expand the program, and is moving to get rid of requirements for people to work in order to receive coverage, which certain states approved during the previous administration.

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 to the eligibility level of children.

Main Findings

Medicaid Coverage by State

Note: With the exception of “Total Score,” all of the columns in the table above depict the relative rank of that state, where a rank of 1 represents the best conditions for that metric category.

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?
5. Are states that have expanded Medicaid better positioned against COVID-19 and a recession?

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 (2019 vs 2011): 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)

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

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