Table 7.8

Medicaid Expenditures (In millions of dollars)


  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
01Alabama (a)7964,9841,1976,977

719

5,3941,0117,1248205,9931,2678,080
02Alaska6721,61042,286

639

1,66062,3056391,798162,453
04Arizona1,7418,5551,83412,130

1,570

9,3061,78712,6631,83912,5992,30816,746
05Arkansas1,2645,6425167,422

1,192

5,8434377,4721,1926,4426318,265
06California (b)22,87655,66110,37988,916

29,476

61,1165,87196,46327,90275,90611,259115,067
08Colorado2,9235,5741,4379,934

3,001

6,3561,40110,7582,8157,5631,65212,030
09Connecticut4,3693,80708,176

4,474

3,92808,4024,5554,27008,825
10Delaware7111,423472,181

678

1,595612,3347101,826462,582
12Florida6,23915,0754,63525,949

5,766

16,2884,59526,6497,13517,3955,13529,665
13Georgia3,0627,66864411,374

2,914

8,76264612,3222,9678,74249812,207
15Hawaii7391,522662,327

701

1,414702,1857961,924772,797
16Idaho6141,4952102,319

568

1,6172302,4154991,7072512,457
17Illinois4,14311,4453,06618,654

4,483

13,2145,76823,4654,04616,4305,41125,887
18Indiana (c)2,5368,5231,22912,288

2,374

10,1201,56414,0582,30511,7861,49715,588
19Iowa1,4533,4608695,782

1,534

3,9169116,3611,4604,6048296,893
20Kansas1,2212,0003093,530

1,081

2,3463583,7851,0372,7203654,122
21Kentucky1,8257,84950710,181

1,973

9,15047811,6011,98011,45166314,094
22Louisiana1,9708,4121,26311,645

1,891

9,3051,37812,5741,82611,3171,36014,503
23Maine8071,8633062,976

821

2,1143233,2587202,4583213,499
24Maryland3,6187,0331,00311,654

3,442

7,3391,02211,8033,6208,32295312,895
25Massachusetts7,9908,5311,32417,845

8,097

8,9261,43718,4608,2389,9101,21319,361
26Michigan (d)2,82612,9752,74818,549

2,541

14,0752,72719,3433,01916,5522,91022,481
27Minnesota4,9337,05555112,539

4,965

7,42858712,9804,7738,46160313,837
28Mississippi6803,8735615,114

711

4,3095105,5305534,4325815,566
29Missouri (e)2,1075,4112,60810,126

1,901

5,7592,84310,5032,4535,8372,87211,162
30Montana3091,3951011,805

281

1,5231511,9553051,8211562,282
31Nebraska1,0341,149352,218

1,013

1,239392,2911,0211,832262,879
32Nevada7093,0572704,036

753

3,0702274,0508323,5782714,681
33New Hampshire6551,2562812,192

614

1,2372712,1226731,5162292,418
34New Jersey4,5989,8161,25015,664

4,401

10,6081,36016,3694,15012,8631,38718,400
35New Mexico9234,4343195,676

966

5,3983926,7569046,0403437,287
36New York (f)15,59739,0945,68360,374

18,479

40,0855,68464,24814,92544,2455,47564,645
37North Carolina3,7599,4841,04414,287

3,653

10,4651,87315,9913,69111,6991,80417,194
38North Dakota47272661,204

471

73091,210393800811,274
39Ohio (g)15,0538,6353,28426,972

4,888

19,9373,56928,3945,35623,4413,15931,956
40Oklahoma9743,3201,4985,792

982

3,4641,0875,5338913,9179305,738
41Oregon9686,9021,4999,369

1,043

7,5631,63910,2458518,5391,78811,178
42Pennsylvania9,29418,5804,50032,374

8,835

21,7963,91034,5419,88823,1334,29437,315
44Rhode Island1,1351,63892,782

1,008

1,590102,6089991,959102,968
45South Carolina1,1824,7518376,770

1,241

5,1287437,1121,1715,4866267,283
46South Dakota3645494917

334

56649043196073929
47Tennessee (h)3,6307,05277711,459

3,600

7,97483812,4124,1078,23074913,086
48Texas11,74223,36132335,426

9,908

27,53323437,67511,38731,96824143,596
49Utah5171,9335472,997

451

2,3156893,4554853,2859654,735
50Vermont (i)5959711101,676

553

1,0081051,6665021,060841,646
51Virginia5,2545,84020711,301

4,791

8,47159013,8524,88510,38779316,065
53Washington4,1407,98457212,696

4,189

8,55862613,3734,26610,15665515,077
54West Virginia6023,1572774,036

459

3,3403654,1643103,8906194,819
55Wisconsin3,1395,6531,75910,551

2,982

6,3871,75611,1253,4097,2262,00112,636
56Wyoming25833336627

257

3233761725732337617
11Dist. of Columbia7932,234833,110

738

2,505813,324N/AN/AN/AN/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.