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“In FY2021, Medicaid spending on services and administrative activities in the 50 states, the District of Columbia, and the territories totaled $748 billion.⁷¹

“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.⁷² In addition, the FFCRA 6.2-percentagepoint increase to the FMAP rates during the COVID-19 public health emergency has increased the federal share of Medicaid since January 2020. In FY2021, the average federal share of Medicaid is estimated to have been 69%.⁷³“

Source: Alison Mitchell, et al. Medicaid: An Overview. CRS R43357. Congressional Research Service: Washington, DC, updated Feb. 8, 2023.

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“In FY2021, Medicaid is estimated to have provided health care services to an estimated 85 million individuals at a total cost of $748 billion, with the federal government paying $518 billion of that total.⁵ In comparison, the Medicare program provided health care benefits to nearly 63 million individuals in that same year at a cost of roughly $875 billion.⁶“

Source: Alison Mitchell, et al. Medicaid: An Overview. CRS R43357. Congressional Research Service: Washington, DC, updated Feb. 8, 2023.

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“For some types of services, Medicaid is a significant payer. For instance, in 2020, Medicaid accounted for about 42% of national spending on LTSS.¹² Medicaid paid for 42% of all births in the United States in 2020.¹³ In 2019, Medicaid paid for 26% of behavioral health services, including mental health and substance use disorder services, which made Medicaid the single biggest payer of behavioral health services.¹⁴

“Medicaid also pays for Medicare premiums and/or cost sharing for low-income seniors and individuals with disabilities, who are eligible for both programs and referred to as dual-eligible beneficiaries. For other Medicaid enrollees, cost sharing (e.g., premiums and co-payments) generally is nominal, which may not be the case with coverage available through the private health insurance market. The Medicaid program is a significant payer for services provided by special classes of providers, such as federally qualified health centers (FQHCs), rural health clinics (RHCs), and Indian Health Service (IHS) facilities that provide health care services to populations in areas where access to traditional physician care may be limited.”

Source: Alison Mitchell, et al. Medicaid: An Overview. CRS R43357. Congressional Research Service: Washington, DC, updated Feb. 8, 2023.

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“As shown in Figure 3, for calendar years 2018 and 2019 together, Medicaid enrollment for children, nonexpansion adults, and expansion adults comprised 77% of Medicaid enrollment but accounted for 44% of Medicaid’s total benefit spending. In contrast, together individuals with disabilities and the aged populations represented less than a quarter (23%) of Medicaid enrollment but accounted for more than a half of Medicaid benefit spending (56%).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 Feb. 8, 2023.

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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 March 17, 2025 by Doug McVay, Editor.