What share of Medicaid costs do states pay?

Refreshed annually
The state share of Medicaid ranged from 17.9% in New Mexico to 40.3% in Wyoming in fiscal year (FY) 2023. On average, states paid 31.1% of the overall spending on the health insurance program, with the rest coming from the federal government.

31.1%

average state government share of Medicaid spending (FY 2023)

17.9%

lowest state government share (New Mexico) of Medicaid spending (FY 2023)

40.3%

highest state government share (Wyoming) of Medicaid spending (FY 2023)

A state’s share of Medicaid spending is influenced by its Federal Medical Assistance Percentage (FMAP), which is a federal formula based on per capita income. The idea is to provide more federal support to states with lower incomes relative to the national average.

  • Baseline match: If a state’s per capita income equals the national average, the federal government covers 55% of that state’s Medicaid costs.
  • Lower-income states: States with lower per capita incomes receive a higher match, up to 83%, meaning the federal government pays a larger share.
  • Higher-income states: Even the wealthiest states receive a minimum federal match of 50%, so the federal government always pays at least half of Medicaid costs.

New Mexico covered the lowest share of Medicaid costs among state governments, while Wyoming covered the highest.

State government share of Medicaid costs (FY 2023)

The FMAP is just a baseline. For example, states that expanded Medicaid under the Affordable Care Act receive an enhanced federal match (90%) for newly eligible adults. Other services may receive lower or flat-rate matches, and some may be entirely state-funded.

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In FY 2023, the latest year in which federal and state government spending data is available, state governments have on average covered 31.1% of Medicaid costs with the federal government covering the remaining 68.9%. The state government share of costs is down from 39.2% in 2014, the year Medicaid expansion began.

In FY 2023, the federal government covered 68.9% of Medicaid. State governments covered the rest.

Medicaid spending, by level of government

How will the One Big Beautiful Bill Act affect the state share of Medicaid?

In 2025, Congress passed the “One Big Beautiful Bill,” which limits how states can fund and structure their Medicaid programs. While the base 90% federal match for expansion adults remains in place, the bill makes several changes that may result in states taking on a larger share of Medicaid costs. This includes:

  • Ending the temporary 5-percentage-point FMAP bonus that was available to states if they newly expanded Medicaid after 2021.
  • Reducing or eliminating federal reimbursement for certain services, such as emergency care for undocumented immigrants.
  • Requiring states to implement work requirements and cost sharing for some adults eligible through Medicaid expansion.

State share of Medicaid costs, FY 2023

State share of Medicaid costs, FY 2023
StateShare
1.

Wyoming 

40.3%
2.

Massachusetts 

39.4%
3.

New Hampshire

38.3%
4.

Colorado 

36.7%
5.

Minnesota 

36.6%
6.

Connecticut 

36.6%
7.

Pennsylvania 

36.5%
8.

Maryland 

36.5%
9.

New York

36.4%
10.

New Jersey

36.0%

Steve Ballmer explains Medicaid in under eight minutes

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Methodology

USAFacts standardizes data, in areas such as time and demographics, to make it easier to understand and compare.

Page sources

USAFacts endeavors to share the most up-to-date information available. We sourced the data on this page directly from government agencies; however, the intervals at which agencies publish updated data vary.