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“Enrollment increases due to expansions of eligibility and economic downturns account for much of Medicaid’s expenditure growth over time. However, Medicaid expenditures are influenced by economic, demographic, and programmatic factors, along with health innovations and advances. Economic factors include health care prices, unemployment rates,⁶⁸ and individuals’ wages. Demographic factors include population growth and the age distribution of the population. Programmatic factors include state decisions regarding optional eligibility groups, optional services, and provider payment rates. Other factors include the number of eligible individuals who enroll, utilization of covered services, and enrollment in other health insurance programs (including Medicare and private health insurance).”

Source: Alison Mitchell, et al. Medicaid: An Overview. CRS R43357. Congressional Research Service: Washington, DC. Updated April 30, 2025, last accessed February 12, 2026.

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“Historically, in a typical year, the average federal share of Medicaid expenditures was about 57%, which means the average state share was about 43%. However, the federal government’s share of Medicaid expenditures increased since the implementation of the ACA Medicaid expansion in January 2014, because the federal government is funding a vast majority of the cost of the expansion through the enhanced federal matching rates.⁷⁰ In addition, the FFCRA 6.2-percentage-point increase to the FMAP rates during the COVID-19 public health emergency has increased the federal share of Medicaid from January 2020 through December 31, 2023.⁷¹ In FY2023, the average federal share of Medicaid is estimated to have been 69%.⁷²“

Source: Alison Mitchell, et al. Medicaid: An Overview. CRS R43357. Congressional Research Service: Washington, DC. Updated April 30, 2025, last accessed February 12, 2026.

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“Different Medicaid enrollment groups have different service utilization patterns. Larger enrollment groups account for a smaller proportion of Medicaid expenditures, while some smaller enrollment groups are responsible for a larger proportion of Medicaid expenditures. Individuals with disabilities and the aged populations tend to be sicker and use more health care services, including LTSS [Long-Term Services and Supports], than the children, nonexpansion adults, and expansion adults populations. As a result, the expenditures for the individuals with disabilities and the aged populations are relatively higher.

“As shown in Figure 3, for calendar year 2020, Medicaid enrollment for children, nonexpansion adults, and expansion adults comprised 78% of Medicaid enrollment but accounted for 46% of Medicaid’s total benefit spending. In contrast, together individuals with disabilities and the aged populations represented less than a quarter (22%) of Medicaid enrollment but accounted for more than a half of Medicaid benefit spending (54%).³⁷ Although these statistics vary somewhat from year to year and state to state, the patterns described above generally hold true across years.”

Source: Alison Mitchell, et al. Medicaid: An Overview. CRS R43357. Congressional Research Service: Washington, DC. Updated April 30, 2025, last accessed February 12, 2026.

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World Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems and policies in the US and sixteen other OECD member nations.

Page last updated February 12, 2026 by Doug McVay, Editor.