Table 7.8

Medicaid Expenditures (In millions of dollars)

Available versions: 2023 2022 (showing)

		Actual Fiscal 2019				Actual Fiscal 2020				Estimated Fiscal 2021
FIPS	State or other jurisdiction	General fund	Federal funds	Other state funds	Total	General fund	Federal funds	Other state funds	Total	General fund	Federal funds	Other state funds	Total
	Total	$169,018	$372,516	$62,541	$604,075	$164,402	$424,093	$62,310	$650,805	$163,876	$488,446	$69,444	$721,766
01	Alabama (a)	796	4,984	1,197	6,977	719	5,394	1,011	7,124	820	5,993	1,267	8,080
02	Alaska	672	1,610	4	2,286	639	1,660	6	2,305	639	1,798	16	2,453
04	Arizona	1,741	8,555	1,834	12,130	1,570	9,306	1,787	12,663	1,839	12,599	2,308	16,746
05	Arkansas	1,264	5,642	516	7,422	1,192	5,843	437	7,472	1,192	6,442	631	8,265
06	California (b)	22,876	55,661	10,379	88,916	29,476	61,116	5,871	96,463	27,902	75,906	11,259	115,067
08	Colorado	2,923	5,574	1,437	9,934	3,001	6,356	1,401	10,758	2,815	7,563	1,652	12,030
09	Connecticut	4,369	3,807	0	8,176	4,474	3,928	0	8,402	4,555	4,270	0	8,825
10	Delaware	711	1,423	47	2,181	678	1,595	61	2,334	710	1,826	46	2,582
12	Florida	6,239	15,075	4,635	25,949	5,766	16,288	4,595	26,649	7,135	17,395	5,135	29,665
13	Georgia	3,062	7,668	644	11,374	2,914	8,762	646	12,322	2,967	8,742	498	12,207
15	Hawaii	739	1,522	66	2,327	701	1,414	70	2,185	796	1,924	77	2,797
16	Idaho	614	1,495	210	2,319	568	1,617	230	2,415	499	1,707	251	2,457
17	Illinois	4,143	11,445	3,066	18,654	4,483	13,214	5,768	23,465	4,046	16,430	5,411	25,887
18	Indiana (c)	2,536	8,523	1,229	12,288	2,374	10,120	1,564	14,058	2,305	11,786	1,497	15,588
19	Iowa	1,453	3,460	869	5,782	1,534	3,916	911	6,361	1,460	4,604	829	6,893
20	Kansas	1,221	2,000	309	3,530	1,081	2,346	358	3,785	1,037	2,720	365	4,122
21	Kentucky	1,825	7,849	507	10,181	1,973	9,150	478	11,601	1,980	11,451	663	14,094
22	Louisiana	1,970	8,412	1,263	11,645	1,891	9,305	1,378	12,574	1,826	11,317	1,360	14,503
23	Maine	807	1,863	306	2,976	821	2,114	323	3,258	720	2,458	321	3,499
24	Maryland	3,618	7,033	1,003	11,654	3,442	7,339	1,022	11,803	3,620	8,322	953	12,895
25	Massachusetts	7,990	8,531	1,324	17,845	8,097	8,926	1,437	18,460	8,238	9,910	1,213	19,361
26	Michigan (d)	2,826	12,975	2,748	18,549	2,541	14,075	2,727	19,343	3,019	16,552	2,910	22,481
27	Minnesota	4,933	7,055	551	12,539	4,965	7,428	587	12,980	4,773	8,461	603	13,837
28	Mississippi	680	3,873	561	5,114	711	4,309	510	5,530	553	4,432	581	5,566
29	Missouri (e)	2,107	5,411	2,608	10,126	1,901	5,759	2,843	10,503	2,453	5,837	2,872	11,162
30	Montana	309	1,395	101	1,805	281	1,523	151	1,955	305	1,821	156	2,282
31	Nebraska	1,034	1,149	35	2,218	1,013	1,239	39	2,291	1,021	1,832	26	2,879
32	Nevada	709	3,057	270	4,036	753	3,070	227	4,050	832	3,578	271	4,681
33	New Hampshire	655	1,256	281	2,192	614	1,237	271	2,122	673	1,516	229	2,418
34	New Jersey	4,598	9,816	1,250	15,664	4,401	10,608	1,360	16,369	4,150	12,863	1,387	18,400
35	New Mexico	923	4,434	319	5,676	966	5,398	392	6,756	904	6,040	343	7,287
36	New York (f)	15,597	39,094	5,683	60,374	18,479	40,085	5,684	64,248	14,925	44,245	5,475	64,645
37	North Carolina	3,759	9,484	1,044	14,287	3,653	10,465	1,873	15,991	3,691	11,699	1,804	17,194
38	North Dakota	472	726	6	1,204	471	730	9	1,210	393	800	81	1,274
39	Ohio (g)	15,053	8,635	3,284	26,972	4,888	19,937	3,569	28,394	5,356	23,441	3,159	31,956
40	Oklahoma	974	3,320	1,498	5,792	982	3,464	1,087	5,533	891	3,917	930	5,738
41	Oregon	968	6,902	1,499	9,369	1,043	7,563	1,639	10,245	851	8,539	1,788	11,178
42	Pennsylvania	9,294	18,580	4,500	32,374	8,835	21,796	3,910	34,541	9,888	23,133	4,294	37,315
44	Rhode Island	1,135	1,638	9	2,782	1,008	1,590	10	2,608	999	1,959	10	2,968
45	South Carolina	1,182	4,751	837	6,770	1,241	5,128	743	7,112	1,171	5,486	626	7,283
46	South Dakota	364	549	4	917	334	566	4	904	319	607	3	929
47	Tennessee (h)	3,630	7,052	777	11,459	3,600	7,974	838	12,412	4,107	8,230	749	13,086
48	Texas	11,742	23,361	323	35,426	9,908	27,533	234	37,675	11,387	31,968	241	43,596
49	Utah	517	1,933	547	2,997	451	2,315	689	3,455	485	3,285	965	4,735
50	Vermont (i)	595	971	110	1,676	553	1,008	105	1,666	502	1,060	84	1,646
51	Virginia	5,254	5,840	207	11,301	4,791	8,471	590	13,852	4,885	10,387	793	16,065
53	Washington	4,140	7,984	572	12,696	4,189	8,558	626	13,373	4,266	10,156	655	15,077
54	West Virginia	602	3,157	277	4,036	459	3,340	365	4,164	310	3,890	619	4,819
55	Wisconsin	3,139	5,653	1,759	10,551	2,982	6,387	1,756	11,125	3,409	7,226	2,001	12,636
56	Wyoming	258	333	36	627	257	323	37	617	257	323	37	617
11	Dist. of Columbia	793	2,234	83	3,110	738	2,505	81	3,324	N/A	N/A	N/A	N/A

Source:

National Association of State Budget Officers, 2021 State Expenditure Report.

Notes:

States were asked to report Medicaid expenditures as follows: General funds: all general funds appropriated to the Medicaid agency and any other agency which are used for direct Medicaid matching purposes under Title XIX. Other state funds: other funds and revenue sources used as Medicaid match, such as local funds and provider taxes, fees, donations, assessments (as defined by the Centers for Medicare and Medicaid Services). Federal Funds: all federal matching funds provided pursuant to Title XIX.

The states were asked to separately detail the amount of provider taxes, fees, donations, assessments and local funds reported as Other State Funds. 1. Small dollar amounts, when rounded, cause an aberration in the percentage increase. In these instances, the actual dollar amounts should be consulted to determine the exact percentage increase. 2. “State funds” refers to general funds plus other state fund spending. State spending from bonds is excluded. 3. “Total funds” refers to funding from all sources — general fund, federal funds, other state funds and bonds. For all states, Medicaid reflects provider taxes, fees, assessments, donations, and local funds in Other State Funds. Medicaid reflects provider taxes, fees, assessments, donations, and local funds in Other State Funds.

Key:

N/A

—

Not available.

Footnotes:

(a)	Other State Funds includes Medicaid provider taxes in the amounts of: $396M for FY19; $421M for FY20; and $423M for Estimated FY21.
(b)	Medicaid expenditures include the Departments of Health Care Services, Social Services, Developmental Services, and Aging. The “All Other” category includes Medicaid expenditures for other departments.
(c)	Actuals and estimates for Medicaid are based on official Medicaid forecast presentation figures presented by independent actuary.
(d)	Other State Funds used to match federal Medicaid funds include local funds of $66 million and provider revenues of $2,253 million for FY 2019; local funds of $56 million and provider revenues of $2,263 million for FY2020; and estimated local funds of $80 million and provider revenues of $2,455 million for FY 2021.
(e)	Some community mental health and developmentally disabled programs are included in Medicaid.
(f)	In response to the COVID-19 pandemic, the federal government increased its share of Medicaid funding (FMAP) by 6.2 percent for each calendar quarter occurring during the public health emergency, as such, Medicaid spending shifted from the General Fund to Federal Funds.
(g)	Federal reimbursements for Medicaid expenditures funded from the General Revenue Fund (GRF) are deposited into the GRF. Federal reimbursements for Medicaid expenditures from non-GRF sources are deposited into the appropriate federal fund. Expenditures of GRF federal funds have been removed from the GRF number presented in this report to be consistent with budget presentations in other NASBO surveys.
(h)	Certified Public Expenditures – Local fund from hospitals: fiscal 2019 totals $96 million, fiscal 2020 totals $150 million, and fiscal 2021 totals $150 million. Nursing Home Assessment: fiscal 2019 totals $126 million, fiscal 2020 totals $133 million, and fiscal 2021 totals $135 million. Hospital Assessment: fiscal 2019 totals $327 million, fiscal 2020 totals $707 million, and fiscal 2021 totals $603 million. Ambulance Assessment: fiscal 2019 totals $7 million, fiscal 2020 totals $12 million, and fiscal 2021 totals $11 million. Intergovernmental Transfers: fiscal 2019 totals $100 million, fiscal 2020 totals $100 million, and fiscal 2021 totals $100 million.
(i)	The breakdown of local funds, etc. included in Other State Funds is as follows for fiscal 2019 (in millions): local match provided by schools $28; tobacco litigation settlement funds $20; other $62. The breakdown is as follows for fiscal 2020: local match provided by schools $24; tobacco litigation settlement funds $21; other $60. The breakdown is as follows for estimated fiscal 2021: local match provided by schools $21; tobacco litigation settlement funds $21; other $42.