States spend nearly $40 billion annually on expanded Medicaid coverage under the ACA, according to KFF.
Medicaid is financed by the federal government and the states based on per capita income. The federal funding share varies from 50% to 74%, depending on the state. The ACA expanded Medicaid eligibility in 2014, and the federal government has paid for 90% of expansion costs since 2020.
The ranking below lists state spending in 2023 for adults who have enrolled in Medicaid through the ACA's expansion of the program. It does not include spending on traditional Medicaid or federal spending for the expansion group. Ten states have not expanded Medicaid under the ACA.
How much each state has spent to expand Medicaid:
- California: $3,268,018,800
- New York: $2,689,050,600
- Illinois: $1,895,262,700
- Washington: $1,016,797,100
- Ohio: $789,815,500
- Pennsylvania: $787,076,100
- Michigan: $710,094,100
- Arizona: $709,590,200
- Louisiana: $708,047,200
- Virginia: $692,144,700
- New Jersey: $621,022,700
- Kentucky: $578,826,600
- Oregon: $506,854,800
- Connecticut: $484,935,900
- Indiana: $453,552,600
- Maryland: $399,059,600
- Massachusetts: $373,670,100
- Minnesota: $354,687,500
- Colorado: $332,704,000
- Missouri: $281,864,300
- Arkansas: $277,126,900
- Oklahoma: $233,386,800
- Nevada: $217,824,300
- New Mexico: $211,870,300
- Iowa: $158,525,300
- West Virginia: $145,475,300
- Utah: $113,261,900
- Hawaii: $103,935,500
- Montana: $94,964,700
- Nebraska: $93,805,700
- Delaware: $92,409,500
- Maine: $92,354,200
- Rhode Island: $88,602,700
- Idaho: $86,314,200
- District of Columbia: $77,432,200
- New Hampshire: $50,356,100
- North Dakota: $47,138,000
- Alaska: $38,918,200
- Vermont: $32,495,600
- South Dakota: $960,000